Tag Archives: dual eligibles

Policy experts predicted AHCA’s potential impact on older adults

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: Andy De via Flickr

From higher age-based premiums to cuts in Medicaid funding for dual eligibles, there was much for aging advocates to criticize about the Republicans’ now-failed attempt to repeal and replace the Affordable Care Act (ACA).

Policy experts from several aging advocacy organizations briefed reporters during a March 23 conference call on the proposed American Health Care Act (ACHA). The next day, GOP leadership and the White House decided to pull the amended bill from consideration due to lack of support in the House of Representatives.

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Report: Integrated care improves outcomes for those using both Medicare, Medicaid

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

GraphicStock

GraphicStock

It almost seems like a no-brainer that dovetailing care between Medicare and Medicaid will have positive effects on the population of dual-eligible older adults.

In reality, care and payment under these systems is often fragmented and disjointed, a frustrating scenario for primary care providers and detrimental to patients. A new report  from the Centers for Medicare and Medicaid (CMS) on The Minnesota Senior Health Options (MSHO) program reinforces the need for improved service coordination. Continue reading

Finding fresh ways to report on Medicaid, changes in health care system

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Photo: Phil GalewitzA recent AHCJ chapter meeting featured discussion of Medicaid and story ideas for reporters to pursue. Facing the camera, from left to right, are Rebecca Adams of CQ Roll Call, Joan Alker of the Georgetown Center for Children and Families; Cindy Mann, former head of Medicaid official; and Matt Salo, head of the National Association of Medicaid Directors.

Photo: Phil GalewitzA recent AHCJ chapter meeting featured discussion of Medicaid and story ideas for reporters to pursue. Facing the camera, from left to right, are Rebecca Adams of CQ Roll Call, Joan Alker of the Georgetown Center for Children and Families; Cindy Mann, former head of Medicaid official; and Matt Salo, head of the National Association of Medicaid Directors.

The Washington, D.C., chapter of AHCJ held an event about Medicaid in late October with Matt Salo, who leads the National Association of Medicaid Directors; Cindy Mann, who until January was the top U.S. official in charge of Medicaid at HHS and now works at Manatt, Phelps & Phillips; and Joan Alker, executive director of the Georgetown Center for Children and Families.

Here are some of their insights and story ideas that can help reporters keep this story fresh. Continue reading

Report examines Medicaid’s role in community-based care for dual eligibles

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: Eric Ward via Flickr

Photo: Eric Ward via Flickr

Some low-income seniors who qualify for both Medicare and Medicaid — the dual eligibles — have the chance to age in place in their communities thanks to Medicaid’s coverage of long term services and supports (LTSS). This is especially important for older adults who are juggling multiple chronic conditions and may require help with activities of daily living, like bathing, dressing, or eating.

This is a population at high risk for needing expensive institutional care, and is not the preferred site of care for most people. Community-based LTSS avoids institutionalizing many older adults and is a more cost-effective solution to the growing aging population. Continue reading

Focus on Medicaid as budget debates escalate

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), is a freelance journalist based in Denver and former topic leader on aging for AHCJ. She haswritten for the New York Times, Kaiser Health News, the Washington Post, the Journal of the American Medical Association, STAT News, the Chicago Tribune, and other publications.

Don’t forget about Medicaid as the budget debate occupies center stage in Washington.

Howard Gleckman reminds us why this is so important in a chock-full-of-data blog post at Forbes. I give Gleckman a boatload of credit. He’s one of the few reporters who consistently writes about vulnerable older people – a population that gets far too little attention.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Among the key points in his post: Two-thirds of Medicaid budgets are spent on frail older people and young people with disabilities. One-third of budgets, about $120 billion in total, goes to long-term care.

Older people covered by Medicaid are poor and, many of them, dependent and chronically ill. About 9 million people known as “dual eligibles” are covered by Medicaid and Medicare, and this is a very vulnerable population, Gleckman observes:

According to the Kaiser Family Foundation, one-quarter of elderly who are eligible for both programs need assistance with at least three activities of daily living (such as bathing, going to the bathroom, eating, or dressing). Many are, in other words, helpless.

“Among the 1 million dual eligibles who are the most costly Medicaid patients, nearly half are aged 80 or older, three-quarters need help with 3 or more activities of daily living, three-quarters live in institutions, and one out of every six has Alzheimer’s.”

“Ninety percent are poor or near-poor. More than half have incomes of less than $10,000.”

Many politicians discussing cuts don’t really understand how Medicaid works or who it covers, Gleckman notes. You can be sure this is as true of your state legislators as it is of those in Congress. Continue reading

‘Dual eligibles’ pingpong between programs, getting stuck along the way

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

The phrase “dual eligibles” has always been a mouthful for describing people old enough (or disabled enough) to be on Medicare and poor enough to be on Medicaid.

M.C. Kim, a cardiac patient quoted in Anna Gorman’s nice Sunday  Los Angeles Times piece on the “duals,” comes up with a clear and easy-to-grasp alternative image: pingpong patients.

M.C. Kim had four heart attacks in as many years. Each time, he left the hospital not knowing why his heart had failed.

When he tried to enter a cardiac rehabilitation program to learn how to reduce the odds of having more heart trouble, the Medicare office told him to call Medicaid. The Medicaid office told him to call Medicare. In the end, he said, both denied coverage.

“I was like a pingpong ball,” said Kim, 51, who lives in Los Angeles. “Nobody wanted to take responsibility.”

So Kim kept returning to the emergency room, racking up expensive medical bills for taxpayers.

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

The “duals” get their doctors and hospitals paid for by Medicare, and their long-term care by Medicaid.  (That’s overly simplistic, but you get the main idea.) As they go back and forth between settings, they get caught between two systems that should mesh but often are more like mismatched gears that grind and jam and make noise and get stuck.

Care transitions, a weak point in the health care system in the first place, are particularly disastrous for this population. In fact, the mismatched incentives and insane amount of built-in levers to shift costs may increase the number of care transitions -which boosts costs and create all sorts of opportunities for mishaps and miscommunication that can harm patients.

Gorman’s story is a nice illustration, giving examples from both the elderly and the disabled.  She puts a face behind the red tape.

The health reform law takes some steps toward solutions – although this is a tough problem and it’s certainly too soon to say that the reform law will fix it.

A few pieces of a potential solution:

CMS now has a special office on the duals. I interviewed Director Melanie Bella for Kaiser Health News earlier this year. She  has testified at least twice before committees in Congress: On June 21 (PDF) she went before the U. S. House Committee on Energy & Commerce, Subcommittee on Health and on Sept. 21 (PDF) she was before the  U. S. Senate Committee on Finance. Her testimony can give you an idea of what steps her office is taking and which part is relevant to your state or community.

Medicaid managed care, advanced medical homes, ACOs, penalties for high readmission rates, payment bundling and other reforms may eventually provide better coordinated care for the “duals.” Some of the new programs for the elderly encouraged by the law, such as Independence at Home, may also help. There are more details about delivery system and the duals in this Kaiser Family Foundation brief.

The Alliance for Health Reform also did a whole briefing on this topic a few months ago. This link will take you to resources, an archived webcast, and a transcript (for those of you who would rather skim than watch the webcast)

The SCAN Foundation also has a lot of material on the duals on its website, including this report on state-based solutions.