Sunday, April 17, 2016

Time for Medicare Part LTC?

Periodically we will see observations about whether Medicare should offer a long term care benefit as part of Medicare coverage (would this be Part E or maybe Part LTC?).  It isn't a secret that many often think Medicare has a long term nursing home benefit, confusing what Medicare covers with what Medicaid does. Health Affairs Blog ran a story recently about  Medicare and long term care. Medicare Help At Home offers some sobering data

Nine million community-dwelling Medicare beneficiaries—about one-fifth of all beneficiaries—have serious physical or cognitive limitations and require long-term services and supports (LTSS) that are not covered by Medicare. Nearly all have chronic conditions that require ongoing medical attention, including three-fourths who have three or more chronic conditions and are high-need, high-risk users of Medicare covered services.

Gaps in Medicare coverage and the lack of integration of medical care and LTSS have serious consequences. Beneficiaries are exposed to potentially high out-of-pocket expenses. Medicaid covers LTSS for very low-income Medicare beneficiaries, but only one-fourth of Medicare beneficiaries with serious physical or cognitive limitations are covered by Medicaid.

The authors offer a 3-part proposal that would expand Medicare coverage to include home and community-based coverages:

  1. A Medicare home and community-based benefit for those with two or more functional limitations, Alzheimer’s, or severe cognitive impairment, according to an individualized care plan based on beneficiary goals. This would cover up to 20 hours a week of personal service worker care or equivalent dollar amount for a range of home and community-based LTSS.
  2. Creation of new Integrated Care Organizations (ICOs) accountable for the delivery and coordination of both medical care and LTSS that meet quality standards, honor beneficiary preferences, and support care partners.
  3. Innovative models of health care delivery including a team approach to care in the home building on promising models of service delivery that improve patient outcomes, reduce emergency department use, prevent avoidable hospitalization, and delay or reduce long-term institutional care.

The article goes on to explain eligibility, beneficiary cost-sharing, financing, care delivery and coverage. The article concludes, offering that with the Baby Boomers " the Medicare program ... was not designed to support their [boomers] preferences for independent living and functioning.

Moving forward, adoption of a home and community based benefit in Medicare would constitute an important first step to helping beneficiaries afford the services and support they need to continue living independently. Adoption of innovative models of care emphasizing care at home or in independent living settings would reduce the difficulty and risk of obtaining services in traditional health care settings such as physician offices and hospitals. It would also reduce beneficiary reliance on Medicaid’s safety-net coverage of institutional care. It is a policy proposal worthy of serious consideration as the nation grapples with Medicare redesign to meet the needs of an aging population.

 

 

 

https://lawprofessors.typepad.com/elder_law/2016/04/time-for-medicare-part-ltc.html

Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink

Comments

Unfortunately, the authors didn't tell readers what the next steps were, so the whole thing just hangs there. Frustrating, as even on the modest communication networks of this reader, I sent the Health Affairs piece to many people and many people independently sent it to me. This is definitely something where there are almost certainly large numbers of elders, not to mention their families, care givers and advocates, who's like to know how to be involved and what's next. Perhaps someone at your blog knows one of the authors and could that next-steps info out?

Posted by: Stephen Roop | Apr 18, 2016 6:18:49 AM

The nation will also have to grapple with the labor shortage that is coming down the pike, just as new and/or enhanced programs are being implemented.... that appear to be quite labor intensive.

Posted by: Jennifer Young | Apr 18, 2016 5:58:52 PM

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