Budget hawks have been harping on Medicaid (Medi-Cal in California). For the purpose of this article, I will distinguish the federal issues from the state issues by using Medicaid and Medi-Cal respectively) and Medicare spending over the past few years. Many political debates have focused on who is cutting what from which program, making it difficult to understand which of our leaders have the healthcare interests of the poor and elderly populations in mind. However, every political leader in Delaware is on board with Medicaid and Medicare improvement.
Delaware’s sole representative in the House, John Carney (D-Del.) is the lead Democrat on the bipartisan House bill. Senator Tom Carper (D-Del.), the small state’s senior senator is the lead Senate sponsor of the bill and is joined by Delaware’s junior senator, Chris Coons (D-Del.). The bill, called the PRIME Act, stands for Preventing and Reducing Improper Medicare and Medicaid Expenditures. The bills will seek to reduce Medicare and Medicaid costs without reducing access to services or the services provided. Its primary method of achieving this goal will be through eliminating waste.
Perhaps the most striking attribute of this initiative is that it is a bipartisan effort to reduce waste at a time when very few bipartisan initiatives ever see the light of day. Senator Tom Coburn (R-Okla.) said that the bill is built on the recommendations of health experts for how to make certain the limited resources available go to those who really need it.
Due to the massive size of the two federal programs and the time-sensitive nature of payments, claims often slip through the cracks, costing taxpayers billions. The goal of the current legislation would be to eliminate the payment of fraudulent claims by investigating suspicious claims in advance, rather than the current system which investigates after payment has been made. The legislation would also strengthen penalties for those found to be perpetrating fraud against the organizations. Some of the types of fraud at which the PRIME Act would take aim include people posing as deceased physicians in order to write or obtain prescriptions and individuals who obtain the same prescription from multiple physicians in order to satisfy their addiction or sell the medications.
Additionally, the PRIME Act hopes to increase senior participation in detecting fraud or waste by encouraging seniors to review their quarterly statements on their own. In order to accomplish this goal, the PRIME Act would expand the “Senior Medicare Patrol.” Through increased awareness, expanding into the Medicaid program, and increasing incentives for tips. If you are currently receiving Medicare, you can participate now in order to help reduce waste.
If you are not yet receiving Medicare or Medi-Cal, you may wish to plan for the ability to qualify for Medicaid. Although virtually everyone will qualify for Medicare, Medi-Cal is a need-based program that looks at your assets to determine whether you can pay your medical bills. Through proper planning in advance, such as through a QMap Trust, it is possible to preserve assets for your surviving spouse and children rather than risk driving yourself into near-impoverished conditions to qualify. Particularly when long-term care is needed, Medi-Cal is an excellent resource but must be done properly to minimize any penalty period or estate recovery.
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