Additional Extended Care Coverage Dependent on States Says John Marshall Law School Expert

(PRWEB) June 29, 2012

Future increases in coverage for extended care benefits will now be dependent on what state you live in, according to Barry Kozak, director of the Elder Law Program at The John Marshall Law School in Chicago.

“We know that many individuals, including seniors, struggle to afford medical care,” Kozak noted. “In the Affordable Care Act, Congress stipulated a way to make it easier for many individuals in the limited income bracket to get the necessary care through Medicaid, but the Supreme Court ruled Thursday that the threat to withhold federal funds for a state’s current version of Medicaid is unconstitutional and exceeds Congress’ authority.”

While Medicaid essentially covers medical care for indigent children, elderly individuals, pregnant women and disabled individuals, it also covers persons who need extended long term care with activities of daily living, such as bathing, dressing, feeding, etc. Many nursing home residents are Medicaid patients who are indigent and who cannot afford between $50,000 to $75,000 per year charged by nursing homes.

The legislation does allow the federal government to reward states that voluntarily comply with the new coverage requirement by 2014. The Supreme Court held that states that increase the threshold from 100 percent to 133 percent of the poverty level for certain indigent individuals will receive additional funding.

“The Supreme Court’s position essentially allows states to continue operating their Medicaid Programs as they have been,” Kozak added. “The federal government will continue to provide its portion under the pre-ACA rules, but it cannot mandate that states increase the eligibility for coverage.” Chief Justice Roberts came to this conclusion, and six of the other Supreme Court Justices agreed with this portion of his opinion. If Justices Ginsburg and Sotomayor had their way, the wording and operation of the Medicaid expansion under the Affordable Care Act would have been deemed constitutional.

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