House Republicans have proposed a major rewrite of the Affordable Care Act that would increase the cost of health insurance for older workers and profoundly change the Medicaid support system for the most vulnerable. It would be the biggest change in government assistance for long-term care since the creation of Medicaid a half century ago. The proposal would retain the [...]
The Trump Administration and congressional Republicans seem to be moving full speed towards capping federal payments for Medicaid--a design sometime called block grants. But they may be missing a key piece of the story: Two-thirds of the program’s dollars go to the frail elderly and younger people with disabilities. The stereotype of a Medicaid beneficiary is a poor mom and [...]
Medicaid long-term care is rapidly changing, and some of those trends may eventually remake the way all of us receive personal assistance as we age or become disabled. Nearly half of all states are now providing Medicaid long-term care benefits through managed care, and 13 states are requiring older adults to receive care that way. At the same time, four [...]
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 [...]
House Speaker Paul Ryan’s proposed blueprint for health reform would make major changes in medical care for seniors, raising out-of-pocket costs for some and shifting others from traditional Medicare coverage to commercial insurance. His plan, called A Better Way, would slowly raise the age of eligibility for Medicare and cap federal spending for the program, increasing subsidies for low-income seniors [...]
Federal regulations are finally catching up with a decade of seismic change in the delivery of Medicaid services. More than 650 pages of proposed new rules are aimed at overseeing managed care, which has become the standard health care delivery system for low-income adults and children, and is now being expanded to include both medical care and long-term supports and [...]
President Obama’s 2016 budget would make important changes in the way personal care is delivered to older Americans and younger people with disabilities. The biggest: A plan that could be a major step towards ending Medicaid’s long-standing bias in favor of nursing homes. At the same time, the fiscal plan would modestly boost funding for some senior services programs. While [...]
What if they gave a managed care plan and nobody came? That seems to be the problem with California’s ambitious effort to enroll more than 400,000 low-income seniors and younger people with disabilities into a fully-integrated care program that covers both medical treatment and long-term supports and services. The idea has enormous promise, but relatively few Californians seem willing to [...]
The quality and accessibility of long-term supports and services depends in large part on where you live, according to a new report by AARP, The Commonwealth Fund, and the SCAN Foundation. Eight states—Minnesota, Washington, Oregon, Colorado, Alaska, Hawaii, Vermont, and Wisconsin—provide the best care by nearly all of AARP’s measures. Kentucky, Alabama, Mississippi, Tennessee, West Virginia, and Indiana provide the [...]
The loud debate over how many people have gotten health insurance under the Affordable Care Act misses the point. Yes, reducing the number of uninsured was one goal of the ACA. But only one. The law’s most enduring legacy will come from its historical—but largely unnoticed—changes in the way health care is delivered. Unlike the insurance expansion, which largely excludes Medicare, many [...]