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 [...]
The other day, I wrote about a troubling report on the high likelihood of falls or medication errors in skilled nursing facilities. The problem is real and serious, but at least we can measure it-- which is a first step towards fixing it. In contrast, there is home care. More than eight of every 10 people who need long-term supports [...]
Federal senior services programs are in for another very difficult year. In the 2015 budget he released yesterday, President Obama proposed freezing or even cutting spending for many key programs. And Obama’s blueprint may be the highwater mark for many initiatives, which are likely to see even deeper cuts as the budget works its way through Congress. Key House Republicans have [...]
The most important trend in care for the frail elderly and younger people with disabilities may be what’s called managed long-term supports and services, or MLTSS. This effort to combine medical care with long-term care would replace today’s disorganized, ineffective, and even dangerous system with one that can bring together complex care that’s being delivered by many different providers. Done [...]