Medicaid

Over the last year, the media have been flooded with stories about upper- middle income and rich elderly transferring large amounts of financial assets to their relatives so that they can qualify for Medicaid, the federal/ state health program for the poor. Although this practice has allegedly been going on for years, it is now believed to be reaching epidemic proportions. The elderly are portrayed as the new "welfare queens," bilking welfare into paying for their nursing home care and, thereby, forcing cutbacks in Medicaid benefits for low-income children and adults.

For the last three decades, the federal government has reached out to the poorest of America's citizens - low-income women with children, the disabled and the elderly - and guaranteed them access to basic health care. That guarantee may soon end as Congress completes its work on sweeping legislation to balance the federal budget by 2002. Although President Clinton has threatened to veto the bill, Republicans have vowed to revive its provisions. Under measures approved by both the House and the Senate, federal spending on Medicaid, the government's health-insurance program for the poor, would be capped and the money funneled to the states in lump sums known as block grants.

The New Jersey Public Advocate's Office is investigating allegations that a company operating eight assisted-living facilities in South Jersey improperly discharged residents when their savings ran out. Public Advocate Ronald K. Chen is scheduled to appear in Superior Court here on Thursday to ask a judge to enforce a subpoena issued against Assisted Living Concepts Inc. of Milwaukee. Laurie Facciarossa Brewer, a spokeswoman for the Public Advocate's Office, said the agency, which has subpoena power, learned of the allegations late last year.

Independent pharmacists, saying the state has turned a blind eye as hundreds of them have been driven out of business by rock-bottom Medicaid reimbursement rates, have taken their case to court. In a series of lawsuits filed in state and federal courts, the pharmacists say the state has violated federal law for more than two years by allowing them to be underpaid for prescriptions by managed-care organizations that serve Medicaid clients in the Philadelphia area. The lawsuits paint a stark picture of the decline of the Philadelphia area's independent pharmacies, and say the state bears the blame for a tide of store closings in the last two years.

The Public Interest Law Center of Philadelphia charged yesterday that the federal government is unlawfully denying drug and alcohol treatment to thousands of eligible poor people across the country, including at least 5,000 in Pennsylvania. In a lawsuit filed in U.S. District Court, the law center asked the court to ensure that such treatment is made available "with reasonable promptness" to all low-income people who qualify under Medicaid. "Drug and alcohol addiction is the number-one curable national health problem," the lawsuit states.

A Montgomery County health and human services company, accused of defrauding the federal government through false Medicare and Medicaid billings, has agreed to pay a $7.8 million fine to end a four-year federal investigation. Northwestern Human Services, a $240 million not-for-profit firm based in Lafayette Hill, also agreed to plead guilty to two related federal mail-fraud charges, U.S. Attorney Patrick L. Meehan said yesterday. Meehan said the NHS fraud victims were patients, many of them children, with serious mental and emotional disorders who "weren't getting the treatment they needed and deserved.

MAYS LANDING, N.J. - Phil Venezio worked for 30 years selling laboratory equipment to schools and industry. He supported a family, paid taxes, saved what he could. Last year, illness and disability overwhelmed him so fast, at age 55, "it felt like a dream," he said. "Could this be me?" He couldn't work, lost his job, and with it, his health insurance. Venezio now receives $1,988 a month in disability from Social Security, which he paid into all his adult life. This is not enough to afford private health insurance for him and his wife, Kathy, he said.

Republican governors asked Congress yesterday to let them run Medicaid with no federal strings attached. But Democrats warned of a struggle over how to divide the block grants to states. The House Commerce health subcommittee, which under Democratic leadership in years past engineered a vast expansion of Medicaid and its mandates, now is trying to carry out GOP plans to convert it to a block grant and cut the growth in federal spending in half. "The Medicaid system is outdated and out of control," Illinois Gov. Jim Edgar testified.

Ongoing patient-care problems at the Montgomery County Geriatric and Rehabilitation Center have prompted the federal government to threaten to withhold Medicaid and Medicare reimbursement for new patients at the Royersford nursing home beginning Saturday, surprised county commissioners said yesterday. The threat to withhold funds came in an April 1 letter addressed to facility administrator Jean John from Claudette Campbell, associate regional administrator of the U.S. Department of Health and Human Services.

The praise was faint but the criticism was, for the most part, muted as well during a hearing on the state's new effort to let Philadelphia-area counties run managed-care programs for poor people with mental illnesses and addictions. The two-day hearing in Philadelphia before members of the House Health and Human Services Committee, which ended yesterday, drew about 20 speakers. Most represented providers of behavioral-health-care services to Medicaid clients. Several speakers said that they had had trouble getting health-maintenance organizations to accept responsibility for care, especially for patients with both mental and physical problems; that HMOs had been paying their bills too slowly; and that grievance procedures were inadequate.