Medicare Trends and Recommendations: a summary and analysis of nearly 42,000 questions and issues posed through the Medicare Rights Center’s national consumer helpline and professional email channel during 2020-2021.
Advancing States Medicaid Integration Tracker The State Medicaid Integration Tracker is published bimonthly by Advancing States. It is intended to provide a compilation of states’ efforts to implement integrated care delivery-system models managed long-term services and supports (MLTSS); state demonstrations to integrate care for dual eligible individuals and other Medicare-Medicaid coordination initiatives; other LTSS reform activities, including: balancing Incentive Program, Medicaid State Plan Amendments under §1915(i),Community First Choice Option under §1915(k),Medicaid Health Homes.
Medicare spending on socially isolated adults: an AARP Public Policy Institute report finds a lack of social contacts among older adults is associated with an estimated $6.7 billion in additional Medicare spending annually. The study’s findings raise issues for Medicare and public health officials.
Medicare Observation Status Toolkit from the Center for Medicare Advocacy: created to help beneficiaries, families, advocates and providers understand and respond to an “outpatient” Observation Status designation. The Toolkit contains the CMA’s Observation Status Infographic; Frequently Asked Questions; A Fact Sheet, Summary & Stories from their partners in the Observation Coalition; A Sample Notice (the MOON); a Recorded Webinar (slides in the printable .pdf); Beneficiary/Advocate Q&A; and a Self-Help Packet.
State Medicaid Integration Tracker: Published by the National Association of States United for Aging and Disabilities (NASUAD) which keeps tabs on managed long-term services & supports, state demonstration projects and other LTSS activities.
Understanding what’s next for Medicaid (July 7, 2017): This webcast from the Alliance for Health Policy looks at the potential implications of proposed Medicaid funding changes for at-risk populations – children, the disabled and elderly. Transcript, speakers’ presentations and contact list are included.
Impact of Changing ACA Age Rating Structure a Miliman Research Report, conducted for AARP Public Policy Institute shows that changing the 3:1 limit on age rating to 5:1 would significantly raise premiums for older adults relative to younger adults, minimally impact overall enrollment, and increase federal spending.
Justice in Aging Issue Brief: How Medicaid funding caps would harm older Americans. Importantly, they could limit medically necessary care.
State Health Care Spending, a May 2016 report from Pew Charitable Trusts. The report examines spending and trends for various programs, from Medicaid to Children’s Health Insurance. It looks at the impact of the Affordable Care Act on spending and roadblocks to comprehensive evaluation. Many elderly are “dual eligibles” – low-income seniors who receive benefits under both Medicare and Medicaid. How states choose to spend Medicaid dollars can directly affect their health and quality of life.
Medicare Trends and Recommendations: An Analysis of 2014 Call Data from the Medicare Rights Center’s National Helpline
In 2014, the Medicare Rights Center’s (Medicare Rights) staff and helpline volunteers fielded more than 17,000 questions and issues through the organization’s national consumer helpline. Callers included over 11,000 Medicare beneficiaries and caregivers across the country. As in previous years, callers were geographically and socioeconomically diverse, and needed help with a wide array of complex Medicare issues.
CMS has released a new Medicare Part D Prescriber Look-up Tool. Data from the 2013 Medicare Part D Prescriber Public Use File can now be easily searched to find information on drugs prescribed by physicians and other practitioners for Medicare beneficiaries. Information available include drug name, number of prescriptions dispensed (including original prescriptions and refills) and drug cost.
On July 28, 2015, CMS released updated Medicare state-by-state enrollment numbers, which show that more than 55 million Americans are covered by Medicare. In comparison, approximately 19.1 million Americans were covered by Medicare in 1966. In 2012, there were nearly 52 million beneficiaries covered by Medicare. The jump in enrollment over the past three years is attributable to the first wave of Baby Boomers retiring. CMS also released state-by-state Medicaid enrollments on a monthly basis. As of May 2015, over 71.6 million individuals were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) with 12.8 million more gaining coverage since 2013. More information is available on Medicaid.gov. This chart provides stats on enrollment as of May 2015 in the various types of plans.
CMS has released Home Health Compare, which allows consumers to assess quality of patient care star ratings on an agency’s relative performance for 9 of the 29 quality measures. Ratings are calculated using information from patient assessments performed by the HHA and from Medicare claims submitted by the HHA.
The nation’s population of older adults is growing, and a new report from the Kaiser Family Foundation, “The Rising Cost of Living Longer: Analysis of Medicare Spending by Age for Beneficiaries in Traditional Medicare,” predicts a continuation of this upward trend. By 2050, the number of people 65 and over “..will nearly double, the population ages 80 and older will nearly triple, and the number of nonagenarians and centenarians—people in their 90s and 100s—will quadruple.” The KFF report evaluates the implications of this trend for Medicare and the federal budget, and examines how providers will meet the needs of an older population. A Health Affairs companion article provides some analysis for certain findings in the report.
CMS consumer guide to observational status
An easy-to-understand two-page explanation of what it means to be an in-patient or under observation, and what Medicare will and will not pay for. Although the language is pretty basic, it’s a helpful overview of exactly what the price of admission (or no admission) may cost.
The 2014 OIG work plan sets up how the Inspector General’s office will scrutinize claims that CMS pays to hospitals, nursing homes, and home care agencies, as well as for prescription drugs, medical equipment and other care services. Among them: Part A (inpatient claims, such as the two-midnight rule for hospital admissions, high level-therapy at SNFs, interrupted long-term facility stays, new oversight of hospital pharmaceutical compounding, and questionable Part B claims. There is a wealth of potential story ideas within the report, particularly when coupled with available data from Hospital Compare, Nursing Home Compare and Home Health Compare.
Medicare Fact Sheet (Primer) from Kaiser Family Foundation: How much do you know about Medicare? This super-detailed and easy to understand “Medicare at a Glance” primer is almost guaranteed to make you more knowledgeable. Well thought out graphs and charts add to understanding of necessarily dry facts & figures. Go learn something new.
100 FAQs about Medicare
The Essentials:
What is Medicare
The finances of Medicare
Projections for growth in Medicare from Congressional Budget Office
Medicare Payment Advisory Commission, June 2011 data book
Medicare: The basics, the politics and the resources
How Medicare Works with Employer-Based Insurance
Out-of-pocket spending by Medicare members:
Health spending by Medicare households
Advocacy groups:
National Committee to Preserve Social Security and Medicare
Dual Eligibles: Some seniors have so few resources that they qualify for both Medicare and Medicaid, a joint federal/state program for the poor. An overview of dual eligibles
Community-based Care Transitions Program
Comprehensive Primary Care Initiative
Health Care Innovation Awards
Independence at Home Demonstration Project
Innovation Advisors
The Innovation Center chose 73 individuals out of 920 applicants to help spur delivery system reform in their communities and provide expertise in health care finance, health system analysis and other specialties. Their names and affiliations are available online.
Pioneer Accountable Care Organizations (ACOs)
There are several types of ACOs, each with a slightly different twist. In December 2011, the Innovation Center named 32 “Pioneer ACOs” at health care systems throughout the country.
Another type of ACO is already a permanent part of Medicare, within the Medicare Shared Savings Program (MSSP).