My friend Dan Timmel died last week. You probably didn’t know him. But if you are a frail older adult or a younger person with disabilities who is a Medicaid recipient, a family member of someone on Medicaid, or a taxpayer, you owe Dan a great debt.
Dan was a senior career official on the Medicaid side of the Centers for Medicare and Medicaid Services (CMS), the federal office that oversees both programs. He had a simple vision: People who receive long-term supports and services from Medicaid should get the best and most appropriate care possible. And he worked relentlessly to make that happen.
That led him, long before nearly anyone else in government, to the idea of person-centered care: the then-radical notion that care should be tailored to the human being getting services, and that she and her family should have a say in how it is designed.
Dan’s main focus was on home and community based care, the setting favored by most frail older adults and nearly all younger people with disabilities. But he also recognized that not everyone could live at home. So he helped expand Medicaid home and community care to include assisted living facilities and bring the concept of person-centered care into nursing home regulations. The new nursing home rules released just last week by CMS have Dan’s fingerprints all over them.
It was simply not acceptable to Dan that Medicaid beneficiaries get second-class care. It offended his sense of fairness, good management, and common sense. Medicaid spends close to $120 billion-a-year on long-term supports and services. Why not, he asked again and again, spend it in the most effective way possible.
When confronted with some government rule or provider practice that misdirected that care, Dan would hit the side of his head with an open palm and say, with incredulity, “I don’t get it.” And then he’d set about to fix it.
He didn’t win every battle. No one could. But he won more than any of us had a right to expect.
Dan succeeded because of his deep commitment to the most vulnerable—and Medicaid long-term care beneficiaries are among the sickest and poorest among us. But passion wasn’t the only secret to his success.
Dan was tireless, but his relentlessness was leavened by a twin sense of humor and absurdity. He understood that the CMS bureaucracy was enormous, and like all large enterprises was often driven by an almost-pathological aversion to taking risks. He also understood that the agency was constrained by the law. If CMS did not have the legal authority to do something, it could not do it, no matter how good the idea was.
But thank goodness legal authority is often subject to interpretation. And though Dan was a social worker by training, he often found ways to convince the lawyers to let good ideas happen. And when that didn’t work, he helped convince Congress to change the law.
Dan did not do this work alone. He’d never suggest otherwise. He had support from some in CMS and beyond. But he was the disruptive force who drove important change. He delighted in turning over apple carts–or conventional wisdom that was unsupported by evidence.
Unlike so many others in the long-term care world, Dan saw the benefit of building bridges. Medicaid is an awkward partnership among the federal government, the states, providers (such as nursing homes, assisted living facilities, and home health agencies), and those receiving care.
No one would ever accuse Dan of being naïve. He understood better than most the tensions among those uncomfortable partners. But he got everyone to sit down and find workable solutions. They might not be perfect (and it took Dan a long time to come to grips with that), but they’d be better than the status quo.
A few weeks before he died at just 62, Dan and I sat in his living room and talked about his life. And I realized that while Dan was a visionary, he was also a practical, analytical, hard-headed builder of things. You won’t be surprised to know that Dan made furniture, and that he lovingly restored his nearly 200 year old home.
And that’s how he was with Medicaid long-term supports and services. He’d identify a way to make a better Medicaid, find the right tools, measure twice, and build it. That’s how he was making person-centered care part of the very culture of Medicaid. He was far from finished: Too often, people say the words without quite understanding what they mean. But Medicaid is starting to deliver the goods.
Of course, Dan’s family will miss him deeply. So will his friends. But if you are receiving long-term supports and services from Medicaid, or have a loved one who is, or pay taxes to support those services, you will miss him too.
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