As 2007 rapidly approaches with the next to last year of President Bush’s term in office, a midterm election determining the makeup of Congress, an emerging field of candidates for 2008, and a new governor in NYS, one cannot help but hope for the affirmative resolution of some of the issues of long term care. In public policy terms this translates into the role of government in assuring the financial costs of care and the service needs of an increasing aging population are met. What is the federal government’s responsibility? What is the responsibility of the states? What is the responsibility of the individual and family to plan for long term care? These questions are not easily answered in this time of high costs of care and conflicting views of governmental and individual responsibility.

As the federal and state costs of Medicaid as the principal public payer of long term care for those eligible for coverage have dramatically increased, ways to limit costs are a primary focus and subject of discussion at the different levels of government.

The Alzheimer’s program monies eliminated in the President’s 2007 budget proposals were restored by Congress for the Alzheimer’s Call Center, the CDC Brain Health Initiative, and the Alzheimer State Matching Grants Program. At the time of this writing, it will not be known whether the Alzheimer’s Association Safe Return® program will be fully funded until the House/Senate 2007 budget compromise takes place. Safe Return is the successful national program working at the community level to provide assistance in finding a person who is missing or becomes lost locally or far from home.

In addition, the House/Senate 2007 research budget compromise has not been concluded. The failure of the House and Senate to call for a substantial increase in the research budget has been of great concern and a major focus of the national Alzheimer’s Association advocacy efforts. The Senate 2007 budget version calls for $660 million for research and the House version for $645 million. (The current 2006 research budget is $652 million.)

The Deficit Reduction Act changes will have a severe impact on Alzheimer’s families in need of long term care for the ill person. These changes include: increasing the look back period for nursing home Medicaid from 36 to 60 months for all transfers of assets; changing the starting date of the penalty period for transfers of assets to delay Medicaid coverage for nursing home care; and making homeowners with home equity of $500,000 (increased to $750,000 in NYS under the state discretion provision) ineligible for nursing home or home care under Medicaid.

In response to the national Alzheimer’s Association advocacy efforts, RxAmerica removed its prior authorization policy for Alzheimer drugs for Medicare Part D beneficiaries. This applies to all FDA-approved Alzheimer medications: Aricept, Exelon, Razadyne, and Namenda. This significant change to its formulary policy will help ensure access to Alzheimer drugs for Medicare beneficiaries enrolled in RxAmerica’s prescription drug plans. In July, Medco also removed its prior authorization requirements in response to the Association’s letter to the Centers for Medicare and Medicaid Services.

Governor Pataki’s budget proposals early in 2006 regarding Medicaid eligibility for non-institutional services including home care/personal care, if passed, would have been severely detrimental to Alzheimer’s persons and their families. The governor had proposed to apply a five year look back and initiate a penalty period for the transfer of assets to establish eligibility for non-institutional services. In addition, he proposed that spousal refusal by the well spouse refusing to contribute income and/or assets to the cost of health care for the ill spouse be restricted to where the refusing spouse was absent from the home. The spousal refusal requirement would have resulted either in divorce, both parties in the home having to be impoverished, or the well spouse having to institutionalize the ill spouse in order to have some income and asset financial protection. In response to advocacy efforts by the Coalition of NYS Alzheimer’s Chapters, the NYC Chapter, and organizations and groups throughout the state, these proposals were rejected by the Legislature, and were eliminated from the budget agreement after a protracted dispute with the governor.

— Ann Berson
Vice President, Director of Public Policy

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