In today's world, it is crucial to have healthcare insurance. So, it can be concerning if your application status is still “Medicaid Pending.” Medicaid Pending status means that your application or your parent’s application has not yet been approved or denied. Essentially, your application is in limbo. Here is why this status is important:

• Some elderly patients who suffer from chronic illnesses may see their medical bills pile up while they wait for a final decision from Medicaid.
• Senior patients needing long-term care, like admittance into a nursing home, must pay for nursing home services out of pocket until their Medicaid application is approved.

To avoid mounting medical bills, it is vital that you keep an eye on a senior patient’s application. There are some long-term care facilities that accept Medicaid pending patients. However, the patient or their family may pay a share of the cost of the services in the interim.

A Medicaid application usually takes between 45 and 90 days to process. According to the state where you live, a Medicaid application may take longer or shorter than this estimate. In addition, the time it takes for you to gather the required documents may delay your application.

Applicants and families should keep in mind that most states require proof of the following documents in order to file for Medicaid:

• Birth certificate
• Proof of income
• Proof of identity (i.e., driver’s license, state ID card, green card, or passport)
• Proof of income (i.e., check stubs, tax returns, SSI, or retirement benefit statement)

If your application is denied, patients and families can file an appeal or begin the application again depending on the reason for the denial. If your application is denied because one of the above documents was not included in the original application, you must restart the application from scratch. In cases where you were denied coverage for a substantive issue, you have a right to appeal.

The Appeal Process

The Medicaid appeal process follows these steps:

• Medicaid will send you a denial letter. In the denial letter, Medicaid must explain the reason for the denial. The letter will also state the deadline for filing an appeal.
• The patient must initiate the appeal. To begin your appeal, you must send a notice of appeal to the Medicaid office. You might get contacted by the office, and a Medicaid representative may negotiate a settlement with you to avoid an appeal hearing.
• The final step is an appeal hearing. This appeal is heard in an administrative law court and decided by an administrative law judge. You can present witnesses and evidence at the hearing to persuade the administrative judge to rule in your favor.
• If you want an attorney to represent you but cannot afford it, you can reach out to a legal aid office in your area.

Information about Medicaid is available online at medicaid.gov. Visit this website If you want to learn more about the process of applying for coverage or eligibility. For additional guidance, contact a qualified elder law attorney in your area, as the rules can vary from state to state.

For Americans who are blind or have other visual impairments, reading the instructions or deciphering the results of a traditional at-home COVID-19 rapid test can prove difficult, if not impossible. Tests designed to be more accessible to people with these disabilities are now available for free.

Individuals can place an order for 12 of these more accessible at-home tests, either online through the U.S. Postal Service or by calling 1-800-232-0233. Shipments are made in six separate packages, with two tests included per package.

Using the test requires you to have a compatible, Bluetooth-enabled smartphone and to install a free app. Coupled with the app, the test provides step-by-step directions for performing the test as well as the results in an audio format. If you need additional tests, Medicare will cover up to eight per month, including these more accessible versions.

Supplies are limited. Individuals with disabilities who may need additional help accessing these tests can contact the Administration for Community Living’s Disability Information and Access Line.

Medigap premiums for plans from insurance companies offering the same benefits vary widely, so it pays to be a smart shopper.

Federal law requires that each insurance company offers the same benefits for each of the Medigap plans lettered A through M, but each company sets its own premium rates.

A Medigap insurance company sets premiums in three ways:

• Community-rated, where the premiums are the same, regardless of age
• Issue or entry age-related, where premiums are cheaper if purchased at a younger age
• Attained-age-related, where premiums are based on your age at the time of purchase

When choosing a Medigap plan, compare the different benefits each plan offers and the price for each company’s plan. Consider your current health status, what your health care needs might be in the years to come, as well as your future health care budget.

Insurers will also consider the state and city where you live. The American Association for Medicare Supplement Insurance Price Index reports found the cost in 2022 of a Plan G policy, the most popular Medigap plan, was $99.24 per month in Dallas, Texas, versus $278.25 per month in New York City.

When shopping for a Medigap policy, get quotes from two or more insurance agents working for different insurance brokers. Every insurance broker may not represent all of the insurers offering a plan in the state or city where you live.

It may take time to shop around, but the money you save can be worth it.

Learn more about choosing the right Medigap policy.

Today, more than 1.4 million individuals live in Medicare- and Medicaid-certified nursing homes across the United States. As part of an effort seeking to improve the health and safety of nursing home residents nationwide, the Centers for Medicare and Medicaid Services (CMS) released updated guidance in June for the state agencies that are responsible for surveying long-term care facilities and investigating complaints.

The wide range of updates include the following:

• Nursing homes must provide data on their staffing, which the CMS will use in a research study aimed in part at establishing minimum staffing level requirements for these facilities.
• LTC facilities will be required to employ at least one part-time, on-site infection preventionist who meets the needs of the facility and oversees an effective infection prevention and control program.
• Nursing home surveyors across states will need to investigate complaints and reports of abuse in a timely and consistent manner. A 2019 Government Accountability Office report had previously found that information on abuse was not readily available and that the processes through which incidents of abuse were reported to law enforcement varied widely by state.
• The revisions provide clarifications on various requirements related to nursing homes’ discharge of residents, compliance with arbitration agreements, and the procedures they follow to manage complaints and report incidents.
• Updated mental health guidance targets the inappropriate use of unnecessary medications, such as antipsychotics.
• The CMS also outlines recommendations for nursing homes on limiting occupancy per room to two individuals to help prevent infection while also offering an enhanced level of comfort and privacy for residents. It also urges operators to allow for a greater number of single-occupancy rooms.

Nursing home surveyors will begin to apply the new guidelines in October 2022.

If medical personnel are able to access your medical history during an emergency, it could mean the difference between life and death. But if, for example, you are injured, in shock, suffering from dementia, or are otherwise incapacitated, you may not be able to provide that information yourself.

There are several systems readily available to help make crucial contact and medical history information available to first responders. Consider taking the time to update your details with the following free tools:

• On Your Smartphone: Even when your smartphone is locked, you have options for inputting your emergency contacts as well as other vital information that could help save your life.
   
  • Medical ID for iPhones. If you are an iPhone user, take advantage of the preinstalled Health app to input details about your medical needs so that first responders will have the information they need in an emergency. To do this, open the Health app, choose Review Medical ID, and enter your information.

    You can include not only your designated emergency contacts, but also such details as your birthdate, any medical conditions or allergies, your blood type, and your organ donor status. You can then choose to make your Medical ID available on your iPhone’s lock screen for first responders.

    In addition, there is an option to share your Medical ID information automatically with a dispatcher, should you ever need to make an emergency call.
     

  • Emergency Information on Androids devices. Depending on your device, you may be able to find “Emergency Information” or “My Info” in your Settings, where you can enter your medical details and emergency contacts. Be sure to add anyone you wish to designate as an emergency contact into your Contacts app as well.

    In your Android Settings, you can also add your emergency contact information to your lock screen as a custom message.
     

  • In Case of Emergency (ICE) Contact. This program, which was originally established in 2004, encouraged people to list in their cell phone their “in case of emergency” contacts under the heading “ICE,” allowing paramedics or other medical personnel to know whom to contact in the event of an emergency. Today, there is also a free ICE app for smartphones, which allows you to send an instant message, including your GPS location, directly to your ICE contacts with the tap of a button if you are in an emergency situation. Learn more about ICE.
• The National Next of Kin Registry (NOKR). The NOKR is a free service that allows you to register yourself and your next of kin in the event of such situations as daily emergencies or natural disasters. The information you enter is not available to the public, but it is available to emergency service agencies registered with the NOKR. If you are in an accident, emergency services personnel would be able to search the website to find your next of kin and notify them about your condition. The NOKR stores emergency contact information for those across the U.S. as well as 87 other countries. You can register online, through U.S. mail, or via fax. Learn more about registering for the NOKR.

To get the most out of an emergency contact, you should make sure the person you choose as your emergency contact has agreed to act in this capacity, knows about any allergies or other factors that could affect your treatment, and knows whom to contact on your behalf

An economy that is recovering from the pandemic faster than expected means that the Social Security and Medicare trustees are predicting that both programs’ trust funds will remain solvent longer than they forecast last year. While this is a short-term improvement, major difficulties loom unless Congress acts.  

Social Security retirement benefits and Medicare Part A benefits are financed primarily through dedicated payroll taxes paid by workers and their employers, with employees and employers splitting the tax equally. Employers pay 6.2 percent of an employee's income into the Social Security system, and the employee kicks in the same. For Medicare, the amount is 1.45 percent. Self-employed individuals pay the entire payroll tax. This money is put into trust funds that are used to pay benefits. 

The trustees of the Social Security trust fund now predict that if Congress doesn’t take action, the fund’s balance will reach zero in 2034 – one year later than predicted last year. The main reason for the improved outlook is a “stronger-than-expected recovery from the pandemic-induced recession,” Treasury Secretary Janet Yellen and Labor Secretary Matt Walsh explained in a statement. The report also stated that the disability insurance trust fund, which pays disability benefits, will not be depleted for 75 years. If disability and Social Security benefits are combined, then the programs would be able to pay full benefits until 2035.

Once the Social Security fund runs out of money, it does not mean that benefits stop altogether. Instead, retirees’ benefits would be cut. According to the trustees’ projections, the fund’s income from payroll taxes would be sufficient to pay retirees 77 percent of their total benefit (or 80 percent if the disability insurance fund is included).

The Medicare trust fund’s outlook has also improved slightly. Medicare’s Part A hospital insurance fund, which pays for inpatient hospital services, will be partially depleted in 2028 – two years later than predicted last year. After 2028, the fund will only be able to cover 90 percent of total benefits. 

The trustees emphasized that their estimates are very uncertain due to potential changes in the economy. If the country slips into a recession, both programs will suffer. 

The trustees recommend that Congress take immediate action to address the problem. Steps lawmakers could take to shore up Social Security include eliminating the cap on income subject to tax. Right now, workers pay Social Security tax only on the first $147,000 of income (in 2022). That amount can be increased, so that higher-earning workers pay more in taxes. The Social Security tax or the retirement age could also be increased. Fixing Medicare is more complicated, but some possibilities include lowering drug costs and increasing payroll taxes. 

An advisory issued earlier this month warns people against using a series of adult portable bed rail models after at least three people — including one in a nursing home and another in an assisted living facility — were entangled in them and died of asphyxia.

The U.S. Consumer Product Safety Commission named the following 10 models of Mobility Transfer Systems adult portable bed rails in which it says users may become trapped, resulting in serious injury or death:

• Freedom Grip (model 501)
• Freedom Grip Plus (model 502)
• Freedom Grip Travel (model 505)
• Reversible Slant Rail (model 600)
• Transfer Handle (model 2025)
• Easy Adjustable (model 2500)
• 30-Inch Security Bed Rail, single-sided (model 5075)
• 30-Inch Security Bed Rail – Extra Tall, single-sided (model 5075T)
• 30-Inch Security Bed Rail, double-sided (model 5085)
• 30-Inch Security Bed Rail – Extra Tall, double-sided (model 5085T)

The Commission’s advisory “urges consumers to immediately stop use, disassemble, and dispose of” these bed rails, which have been on the market since 1992 and available through such online retailers as Walmart.com and Amazon.com.

Users can report any incidents related to these rails at www.SaferProducts.gov.

If you are injured due to another person’s negligence and receive Medicaid benefits to pay for care, the state has a legal right to recover the funds it spends on your care from a personal injury settlement or award. Yet in a legal case involving a Floridian teen who was catastrophically injured more than a decade ago, the U.S. Supreme Court this week ruled that states have the right to recover funds that they may spend on future medical expenses, too. 

The decision affects anyone who receives medical care through Medicaid after suffering a disabling injury that results in a lawsuit.  

In 2008, a truck struck 13-year-old Gianinna Gallardo, leaving her in a vegetative state. The state’s Medicaid agency provided $862,688.77 in medical payments on Gallardo’s behalf. Her parents sued the parties responsible, and the case eventually settled for $800,000, of which about $35,000 represented payment for past medical expenses. The settlement also included funds for Gallardo’s future medical expenses, lost wages, and other damages. 

The state Medicaid agency claimed it was entitled to more than $300,000 in medical payments from this settlement, including money that had been specifically allocated for Gianinna’s future medical expenses. 

Gianinna’s parents then sued the agency in federal court, arguing that the state of Florida should be able to recover monies only from that portion of the settlement allocated for past medical expenses. 

When a U.S. district court ruled in favor of Gianinna, the Medicaid agency appealed. A court of appeals reversed the lower court’s decision. Ultimately, the U.S. Supreme Court agreed to hear the case in order to resolve the conflict. 

In a 7-2 decision, the Supreme Court agreed that the state is allowed to recover benefits for Gianinna’s past — as well as future — medical care. Justice Clarence Thomas, who wrote the majority opinion, noted that Medicaid law “distinguishes only between medical and nonmedical care, not between past (paid) medical care payments and future (un-paid) medical care payments.”  

Justices Sonia Sotomayor and Stephen Breyer dissented. They argued that accepting Medicaid shouldn’t leave a beneficiary indebted to the state for future care that may or may not be needed. 

To read the full decision, click here.

While Medicaid helps pay for nursing home care, getting into a nursing home as a Medicaid recipient is not always easy. There are several ways to navigate the process, depending on your situation. 

With the median cost of a nursing home room being more than $250 a day, most families need help paying for long-term care. Medicaid is the primary method of covering the costs for nursing home care in the United States, but in order to qualify for Medicaid, an applicant must have limited income and assets. 

Generally, nursing homes will only accept patients who can pay for their care, while Medicaid will not pay for nursing home care unless an applicant is already living in a nursing home. This creates a predicament: How to get a loved one into a nursing home in order to receive Medicaid? The following are some of the methods you can use to find a nursing home that will accept your loved one:

• Private Pay. The easiest way to get into a nursing home is to be able to pay for care while the resident’s assets are spent down in order to qualify for Medicaid. Residents who can pay privately for a few months can file a Medicaid application once they are in the nursing home and start receiving benefits when the resident’s funds are below their state’s threshold for “countable assets.” Make sure the nursing home accepts Medicaid patients — and get the timing right so that the resident doesn’t run out of funds before the Medicaid application is approved. 

If the resident lacks the funds to pay for his or her own care, the resident’s family could pay. However, this is risky. The family will not be reimbursed if the resident eventually qualifies for Medicaid. It may be possible for the family to lend the money to the nursing home under a written agreement stating that the funds will be returned when the resident qualifies for Medicaid. 

• Medicare. Medicare provides nursing home coverage for up to 100 days of “skilled nursing care” per illness. The patient must enter the nursing home no more than 30 days after a hospital stay that had lasted for at least three days (not counting the day of discharge). The care provided in the nursing home also must be for the same condition that caused the hospitalization (or a condition medically related to it). In addition, the patient must receive a “skilled” level of care in the nursing facility that cannot be provided at home or on an outpatient basis. And finally, Medicare covers care only for people who are likely to recover from their conditions. If a loved one meets these conditions, it is possible for them to enter a nursing home and immediately apply for Medicaid while Medicare pays in the meantime. 
   
• Medicaid Pending. There are some nursing homes that will accept a resident who has applied for Medicaid and is awaiting a response. Unfortunately, there are only a few nursing homes that accept Medicaid pending residents without some type of payment guarantee in the event the application is denied. The nursing homes that accept Medicaid pending residents tend to be those with lower ratings for nursing home quality.  

When moving into a nursing home, be careful about signing a nursing home admission agreement. Nursing homes may try to get families to agree to pay their loved one’s bills if a Medicaid application is denied. Read any agreement thoroughly and have it reviewed by your attorney. 

Navigating the Medicaid process is complicated. If possible, consult with an attorney before entering a nursing home and applying for Medicaid. To find an attorney near you, click here.

If you need a lot of cash on hand upon retirement, Social Security offers a lump-sum payment option that’s worth six months of benefits. However, it comes at a cost. It is important to understand the details before agreeing to the payment.

If you have waited beyond your full retirement age (66 for those born between 1943 and 1954) to begin collecting Social Security benefits, you have the option of asking for back payments. The maximum that Social Security offers is six months’ worth of retroactive payments in a lump sum. The downside is that by taking the lump sum, your retirement date and the amount of your monthly benefit are rolled back six months. 

When you delay taking retirement beyond your full retirement age, you amass “delayed retirement credits” that increase your benefits by 8 percent for every year that you wait, over and above annual inflation adjustments. By taking the lump-sum payment, you lose the delayed credits that you had accumulated over the previous six months, so your monthly benefit will be lower than if you did not take the lump sum — forever.  So, for example, if by taking the six months of retroactive benefits your regular monthly benefit is reduced by $150 and you live another 25 years, you're foregoing $45,000 over that span.  

Whether you should take the lump sum payment depends on a number of factors, including your life expectancy, your spouse’s needs, and what you will do with the new money. Taking the lump-sum payment makes more sense if your life expectancy is shorter. In this case, the immediate cash infusion will be more beneficial than bigger monthly payments. However, if you are married and are the higher earner, you will want to consider your spouse’s needs. If you die, your spouse will receive spousal benefits equal to the monthly amount of your benefits. The higher your benefit, the more your spouse will receive. 

You also need to consider what you will do with the lump-sum payment. If you are paying off high-interest debt or investing in something with a good rate of return, the lump sum might be better than having the higher monthly payment. 

For more information about Social Security, click here.