Milo, Medicaid and Fear

My wife, Barbara and I lost our three dogs between December 2023 and May 2024.  They and their predecessors had been central to our lives for most of our married years. For the first time we were without a dog.  Did we want to have another dog? Did we want to go through the training, the uncertainty, the emotional investment - and ultimately, the heartache of loss?  

After a period of mourning, Milo came into our family in October of 2024 from the Humane Society.  He was a one-year-old lab mix—and big at that—85 pounds (now he is taller and 91 pounds).  When we got home with Milo, he was shy at first and then “enthusiastic”—a little out of control and an escape artist.  His first order of business was “marking” a spot in the house.

Barb and I were anxious of what baggage and issues Milo would bring into our world. What if he continued to “mark”?  What if he was uncontrollable?  What if our fence was inadequate?  What if he was mean or aggressive to people or other animals? What if we made a mistake?

We were fearful of the unknowns. 

Right now, there is a lot of fear of recent federal legislation referred to as the One Big Beautiful Bill (OBBB).  Of concern, and the subject of this article, is how it affects Medicaid.   

While we are still trying to interpret the law, this is what we think we know: Medicaid will involve more red tape, with added processes leading to more denials for failure to act timely or in accordance with the rules. 

The changes include:

For existing Medicaid cases, there will be bi-annual reviews rather than one annual review;

Imposition of work requirements for adults 50-64 who are receiving Medicaid;

Shortened retroactive coverage periods (reduced from 90 to 60 days); and

Cuts to long-term care support. 

When I started practicing elder law in 2004 there was pending legislation which was eventually adopted in early 2006 and named the Deficit Reduction Act (DRA).  It radically changed many Medicaid rules, including eligibility and estate recovery.  There was a lot of fear in many attorneys practicing elder law full or part time, that as a result of the law changes, there was nothing they could do to help clients facing Medicaid.  Many of those attorneys quit practicing elder law altogether. 

By this time in 2006, I was the only attorney in Western Kansas practicing elder law recognized by the National Academy of Elder Law Attorneys.   I was either too new, or too stupid, to bail ship.  I knew I loved working with older adults and helping them navigate the long-term care system—sometimes using Medicaid; sometimes not. 

Instead of quitting, we learned the new rules.  Sometimes we had to fight when the rules were wrong or unfair.  Sometimes the groups I belong to advocated for change, either legislatively or through the court system. 

Despite the DRA, here we are. A Medicaid system chocked full of rules that can be tricky and burdensome, but we’ve figured out those rules so we can take care of our clients—being sure they can find, get and pay for good care, without going broke. 

Barb and I worked with Milo, and by doing so, overcame our fears, and his as well.  Milo is Milo, for good or bad.  We’ve made rules and accommodations for each other and live and act within those rules and accommodations. Those rules will change and evolve.  Now we and Milo are almost inseparable.  He has become my best friend. 

While I don’t pretend the OBBB will ever become my or your best friend, what I can tell you is that our office will adapt and protect our current and future clients and that our office will continue to guide you through the maze of the ever-changing laws.