Medicaid morass

By John P. Lichtenegger

At 10 a.m. on Nov. 4, a hearing was held at the Division of Family Services office in the Marquette Tower in Cape Girardeau to determine if Vicki Litzenfelner Abernathy would regain her Medicaid medical benefits, which were recently terminated.

A number of Vicki's friends attended to provide moral support and to testify on her behalf. Almost everyone in Jackson knows Vicki. For those in Cape Girardeau and the rest of Southeast Missouri, here's the rest of the story.

Vicki is 56 years old and is dying of the killer that took my brother: diabetes. Vicki is dying at a more accelerated rate than the rest of us. She is crippled from this disease.

Vicki was an early bloomer. She was the lifeblood of Jackson High School, a type-A, ultra-outgoing, beautiful girl who led the Jackson High Chiefs Marching Band onto the field. She was active in everything in high school and good or great at everything she did.

After high school, she led the Golden Eagles of Southeast Missouri State onto the field in Houck Stadium, Busch Stadium and the Orange Bowl in Miami for Super Bowl V.

During her years in high school and college, she associated with everyone, not just the beautiful people, of which she was one. Vicki taught this writer and many other late-blooming shy boys how to dance. She was a natural-born leader, cheerleader of many causes and talented lady.

It was while she worked for Braniff Airlines that a vile form of diabetes attacked her body. The diabetes forced her to give up her career as a flight attendant with Braniff. After Braniff, she settled back in to civic life in Jackson, immersing herself in the community she loved. No one volunteered for or accepted more duties than Vicki. From the Jackson Planning and Zoning Commission to running the Heritage Association and a whole lot more, she was there for all of us.

The diabetes was relentless. Diabetes has left her disabled and unemployed. Through the help of friends and U.S. Rep. Jo Ann Emerson, Vicki was able to buy a house which accommodated her disabilities in the Clover Hill Subdivision near Jackson. Her house payment is $496 per month. She was paying for this with her Social Security disability check.

Unless she wins her appeal, she will be required to pay $212 each month for the Medicaid medical benefit that has been sustaining her life. She is caught between a rock and a very hard place. The state wants to deduct $212 from her Social Security disability check to obtain the $212. If she has this deducted or if she pays the $212 for Medicaid, she will not have the money to make her house payment, utilities and meals. She will lose her house unless friends step in to help, and I am sure they will. I will, and so will others.

Vicki, I am sorry, but under the new law you don't qualify.

Here's the reason for this writing. I have suggested to legislators for a long time that estate planning attorneys, myself included, were advising wealthy and some not-so-wealthy clients how to legally qualify for skilled nursing home care by essentially giving away or transferring assets to their children or grandchildren. Attorneys go to continuing legal education seminars to learn how to do this.

So while we are having clients transfer the family farm or hundreds of thousands of dollars from parent(s) to their children in order to qualify those parents for skilled nursing home care in the future, if needed, and to make sure the younger generation gets something from Mom and Dad, Vicki gets caught in the cross hairs of the legislative budget cuts to Medicaid.

Every time we at our law firm complete a procedure that enables two of our clients to qualify for Medicaid (skilled nursing home care), it costs the state and federal government $3,500 per month (less the resident's monthly Social Security benefit, which is applied to the nursing home cost), because on average one of those two qualified will end up in the nursing home. That is $42,000 per year, minus the Social Security.

Ironically, Vicki already qualifies for Medicaid (skilled nursing care) but endures both the agony and joy of caring for herself, by herself, every day. If she enters the nursing home, her net cost to the state of Missouri is $30,960 per year not counting prescription drugs. If she stays at home, the cost is $2,544 per year for the Medicaid medical benefits.

Eliminating the ability for the wealthy to qualify for Medicaid would produce millions for deserving friends like Vicki. Let's urge our legislators to make some adjustments next year.

Until then, Vicki, your friends -- all of those you taught how to dance, the boys of Explorers Post 211, the Marching Chiefs and the Golden Eagles -- will not let you down.

John P. Lichtenegger of Jackson is a lawyer who specializes in real estate law and estate planning.