MANY PARTS of New Hampshire’s proposed Medicaid "modernization" program, called GraniteCare, are troubling. Section B of the program, entitled "Responsibility for Long-Term Care Costs," however, has received little attention. The public comments from the Department of Health and Human Services suggest that the potential ramifications of Section B, particularly its impact on married seniors and nursing homes, have not been fully considered. Because of the complicated nature of this section, it may get little coverage in the media and no public scrutiny. Married seniors and nursing homes should not let this happen. The likely result of Section B is that married seniors will be left more impoverished and nursing homes will lose funding.

What many people do not realize is that the current Medicaid eligibility rules have a devastating financial impact on the healthy "at-home" spouse. Under the current Medicaid rules, the at-home spouse is only entitled to keep one-half of the couple’s combined countable assets, up to a maximum of $92,760. This means that if a married couple has saved, for example, $300,000 in retirement accounts, the at-home spouse must spend down over two-thirds of these accounts before his/her spouse is eligible for Medicaid benefits. Additionally, the at-home spouse generally loses some, if not all, of his/her spouse’s monthly income.

Accordingly, the at-home spouse will often be left with $92,760 (or less) in retirement savings and significantly less monthly income to pay his/her expenses for the remainder of his/her life. Furthermore, what is generally downplayed by the government is the fact that the at-home spouse has often spent years as a full-time, uncompensated caregiver to his/her spouse, saving the taxpayers tens if not hundreds of thousands of dollars.

Yet Section B of GraniteCare makes no attempt to remedy this situation. Rather, it proposes a number of rule changes that would likely have the effect of further impoverishing married seniors. Specifically, Section B states that if the married couple has made gifts within five or 10 years of applying for Medicaid benefits, the at-home spouse would be required to spend down his/her remaining assets below the $92,760 limit (or a lower resource limit in many circumstances).

Although it is not clear from the proposal, it suggests that the gifts must exceed, in total, $7,500 over this five- or-10-year period before a penalty is imposed. There apparently is no exception for charitable gifts, including donations to religious institutions. There also is no apparent exception for seniors who have helped children or grandchildren with education or health care bills, or have simply made holiday gifts. Because many seniors over a five- or 10-year period make gifts that, in total, exceed $7,500, the result will be that many at-home spouses will be required to spend down even more of their retirement savings, below what any other state requires.

In the case of a non-married nursing home resident, who will bear the cost if he or she requires nursing home care? Because single individuals are only permitted to keep $2,500 in countable assets, the answer is likely the private and county nursing homes. Since in many cases the individual is in the nursing home when he or she applies for Medicaid benefits, the result of a finding that the individual is not eligible for Medicaid benefits because of gifts made years earlier will be that the nursing home will not receive reimbursement for the care it provided to the individual. Furthermore, if the "penalty period" is lengthy, the nursing home will be put in the position of deciding whether to file an eviction action against the nursing home resident.

Gov.-elect John Lynch has been reported as stating that no final decisions should be made on GraniteCare until the public has had a chance to review and comment on it. Health and Human Services Commissioner John Stephen has consistently stated that he welcomes public input. It is now time to take advantage of their offers. For the reasons discussed above, married seniors and nursing homes must be part of this dialogue. And Section B must not be overlooked in the process.

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