Coverage Denied. Why is the Federal government telling the chronically ill they deserve no help?

Almost every week for several years, Anne Marie Maffuid received a yellow piece of paper saying that the Medicaid-provided care for her mother would be terminated.

The reason: Maffuid’s mother has ALS and her condition wasn’t improving. ALS is a chronic disease, which, almost by definition, means that her condition is not expected to improve. There is no cure for ALS. Wheelchair-bound, Maffuid’s mother needed help showering and feeding herself, among other things; Medicare paid for a visiting nurse and therapy.

Maffuid is just one of many people who’ve received similar termination notices, says Gill Deford, an attorney with the Connecticut-based Center for Medicare Advocacy, a group that represents Medicare patients . . .

Medicare doesn’t pay for chronic care that is maintenance. The “improving standard” means that the patient has to show that the treatment is presumably short term and is leading to improvement. As a result, people who are released from the hospital to a LTC facility will often receive medicare benefits for a short time if they are improving. Once they become “chronic” or maintenance then medicare doesn’t pay. If people want medicare to pay for such care, the costs would be huge and further strain an already broke program. At that point one uses their own resources first, including savings, long-term care insurance, etc. If that runs out they can access Medicaid which does pay for maintenance. People often think that medicare pays for LTC facilities. It doesn’t, nor does regular health insurance. The point that in-home care is less costly may or may not be true, depending on the client. Medicaid does pay for in-home care and in some cases where the benefits may not be as good for in-home might provide waivers (if it can be shown that in-home is cheaper). This can vary somewhat among states. It amazes me that people on this discussion forum think that medicare should cover LTC. We can’t afford what it covers now, why would we want to make it worse? I’m not criticizing you - I’m just looking through the responses. We went through much the same thing with my grandma. Thankfully, she had enough money to pay her LTC but she died thinking that most of it was covered by medicare and we would all inherit what she had.

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