Frailty, Medicaid And SSI

      People who are desperately poor and disabled file claims with Social Security for Supplemental Security Income. If that claim is approved, they are categorically eligible for Medicaid, but that approval is unlikely to come until at least several months have passed and the wait can easily be far longer than that. How do they get health care in the meantime? Since the Affordable Care Act was passed, in most states, they’ve been able to get Medicaid because of their poverty. The Kaiser Family Foundation has a piece out about what’s in the process of changing on that front. The 2025 reconciliation act requires that as of January 1, 2027 those on Medicaid must meet work requirements. One exception to this work requirement is if the person seeking to get on or stay on Medicaid is “medically frail.” Those familiar with Social Security’s definition of disability know that the term “medically frail” isn’t part of that definition. To the best of my knowledge “medically frail” isn’t part of any definition previously used in any government program in the U.S. The reconciliation act defines “medically frail” to include “five categories of individuals who: are blind or disabled; have a physical, intellectual, or developmental disability that limits their ability to perform one or more activities of daily living (ADL); have a substance use disorder; have a “disabling” mental disorder; or have a “serious or complex” medical condition.” Again, for the most part, this is not Social Security terminology. Other guidance being given the states helps little.

     Who in state government will be handling the workload of determining “medical fragility?” Probably the state disability determination services but they’re already overwhelmed with Social Security work. How long will it take them? It could easily be many months especially since the guidance they’ll receive probably won’t be great, especially at the beginning. The Trump Administration doesn’t have an abundance of Medicaid expertise. Many of the career employees who might have this sort of expertise are no longer working for the government. In the Trump Administration the political appointees who are supposed to be managing this may harbor considerable hostility towards poor people. They may be the sorts of people who naively believe that almost anyone can work and that mental illness is “all in your head.”

     I don’t like how this may all sort out. There may be a lot of disabled people getting all their treatment at hospital emergency rooms? That’s bad for both patient and hospital. At least the hospitals will want a loose definition of “medical fragility.” They want to get reimbursement for the treatment they render and want to keep people who just need outpatient treatment out of their ERs.

I Suppose This Means That Trump Would Rather End Medicaid, Medicare And Social Security Than Negotiate With Democrats

      From Newsweek:

President Donald Trump warned Tuesday that if the Democrats don't approve funding, there are dangers to the future of Social Security and Medicare. 

Trump said at a press conference that when he asked Democrats for feedback on the funding bills, one said, "It means death." 

"There's nothing about death," Trump said. "Theirs is death because they're going to lose Medicaid, they're going to lose Social Security, they're going to lose Medicare, all of those things are going to be gone becausethe whole country would be bankrupt, and you're not going to have any kind of medical insurance." …

     This is Donald Trump’s Administration in a nutshell — governing through threats and intimidation while denying any responsibility for the consequences.  Social Security, Medicare and Medicaid are just “Democrat”programs that he and his party won’t mind destroying? This is lunacy.

Social Security Lump Sums Create Medicaid Problems

 

    Newsweek reports on a problem associated with Social Security that Social Security policymakers probably aren't aware of. The woman in the story had to fight for years for Social Security disability benefits. Finally, she was approved and paid but immediately lost her Medicaid. For SSI purposes, when she received that lump sum of back benefits, she had six months to spend it but there's no six month grace period for purposes of Medicaid. She became ineligible immediately. 

    There are things you can do to spend this sort of lump sum rapidly that give you lasting improvement in your life while retaining Medicaid or at least minimizing your period of ineligibility. You can pay off debts, repair your home which is probably in disrepair since you've been so poor, you can pay down your mortgage, replace worn out appliances and furniture, purchase new clothes, visit family members you haven't seen in years, etc. Just don't give any of it away! The problem is that most people who receive a large sum of money from Social Security or from some other source, such as an inheritance or personal injury settlement, don't see the problem coming and have no idea how to cope with it when it arrives. Often, they give the money to a relative or friend to hold for them which is much worse that useless.

There's Also The Problem That They May Not Have The Money To Put Away

     From the New York Times:

New state-based accounts that let disabled people work and save money without risking the loss of government aid are slowly catching on. But advocates say millions more people with disabilities could be taking advantage of the accounts.

Forty-one states and Washington, D.C., now offer the accounts, which first became available in 2016. The tax-free accounts, known as ABLE accounts, are named after the Achieving a Better Life Experience Act, the 2014 law that created them. ...

But just a tiny fraction of people eligible for the accounts are using them so far.

More than 40,000 ABLE accounts were open by the end of March, with combined balances of about $225 million, said Michael Morris, executive director of the National Disability Institute, a nonprofit advocacy group. But the institute estimates that as many as eight million people are eligible under current rules, which limit the accounts to people who became disabled before age 26. ...

Part of the challenge in fostering more growth is that ABLE accounts have nuanced rules, and states have limited budgets to promote the accounts, said JJ Hanley, director of the Illinois ABLE program. When people do hear about the accounts, she said, they are often skeptical that opening one truly won’t jeopardize their benefits. ...

     ABLE was always about helping well to do parents put away money to help their disabled offspring without jeopardizing their SSI and Medicaid. Most families just don't have the money to put away and there's little to be done about that.
     My thought all along is that ABLE is OK but that we need reforms to remove some of the harshness in the SSI and Medicaid income and resources rules. That would help far, far more people and is long overdue. ABLE targeted a small amount of relief from these rules at a few relatively well off people while ignoring the large number of people who suffer under antiquated income and resource limits.