Patti's Blog - Advocate for Elders, People with Disabilities and Their Families

Is a new study of Medicaid a game changer?

Excerpt from: Politifact (click for full article)

 

The new study in the New England Journal of Medicine was published almost a month after our fact-check ran, and unlike the studies we evaluated initially, it was specifically designed to compare health outcomes for Medicaid patients against those who are uninsured.

Did the new study improve Cruz’s case?

We should note that we evaluate claims based only on evidence known at the time. We don’t go back and re-evaluate if new facts come to light later, because it doesn’t make sense to give people credit for evidence they couldn’t possibly have known about at the time.

In this case, though, we were curious about whether this study changed the debate on this important issue going forward. So we decided to take a fresh look.

The new paper represents the second phase of a study coauthored by Katherine Baicker of Harvard University and Amy N. Finkelstein of the Massachusetts Institute of Technology.

In 2008, Oregon expanded its Medicaid rolls, but only had enough funding to cover a portion of residents who wanted to sign up. To distribute spots in the program, officials set up a lottery.

The researchers compared 6,387 lottery winners to 5,842 who didn’t get a slot, tracking factors such as blood pressure, cholesterol, blood sugar, depression, and out-of-pocket medical spending.

The study produced mixed results. That has led both critics and advocates of expanding Medicaid to rush to portray the study’s results as evidence for their side.  Supporters of expanding Medicaid are pointing to the findings that beneficiaries had less depression and more financial security. Catastrophic out-of-pocket medical expenditures, for example, were "nearly eliminated."

Political battle over Medicaid expansion may cost Michigan hospitals

Excerpt from: Detroit News (click for full article)

 

The outcome of a political battle over Gov. Rick Snyder's proposed Medicaid expansion could have serious consequences for Michigan hospitals, particularly the Detroit Medical Center.

Snyder is among eight Republican governors to break with his party in support of the Medicaid expansion, which is part of Obamacare. And like GOP governors in Arizona, Florida and Ohio, he's been fighting Michigan's Republican-controlled Legislature for support of the expansion.

As part of the proposed expansion, Snyder has recommended eliminating a $20 million payment to the DMC, which the health system has received since 2008 because of its large share of impoverished patients. The DMC cares for 25 percent of Michigan's Medicaid patients, and 40 percent are either on Medicaid or don't have any insurance.

Here’s what the Oregon Medicaid study really said

Excerpt from: Washington Post (click for full article)

 

A few years back, Oregon found the money to add 10,000 residents to the state’s Medicaid program. The only problem was that there were 90,000 residents who qualified for the program and desperately wanted in. So the state held a lottery. Welcome to the American health-care system. Greatest in the world, folks.

But 80,000 Oregonians’ loss was science’s gain. The lottery gave researchers an opportunity that’s almost never available in policymaking: They could create a randomized controlled study — the absolute gold-standard of experimental design — comparing the health outcomes of the lucky Oregonians who received Medicaid to those who didn’t. It would be the first time that kind of study had even been used to compare the insured and the uninsured.

The initial batch of results was released in August 2012. The data covered the first year of the Medicaid expansion and found that the folks on Medicaid were getting more care, reporting better health (both physical and mental), and seeing fewer financial problems than the people who weren’t on Medicaid.

The second set of results was released Wednesday. The data now covers two years and, importantly, includes clinical measures of health rather than relying on the reports of the study participants. These results are more mixed, but also more telling.

Here’s what we can say with certainty: Medicaid works as health insurance.

Medicaid Access Increases Use of Care, Study Finds

Excerpt from: The New York Times (click for full article)

 

Come January, millions of low-income adults will gain health insurance coverage through Medicaid in one of the farthest-reaching provisions of the Obama health care law. How will that change their finances, spending habits, use of available medical services and — most important — their health?

New results from a landmark study, released on Wednesday in The New England Journal of Medicine, go a long way toward answering those questions. The study, called the Oregon Health Study, compares thousands of low-income people in Oregon who received access to Medicaid with an identical population that did not.

It found that those who gained Medicaid coverage spent more on health care, making more visits to doctors and trips to the hospital. But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures. It did, however, substantially reduce the incidence of depression, and it made them vastly more financially secure.

Without Medicaid reform, mentally disabled will suffer even more

Excerpt from: The Oakland Press (click for full article)

 

Expanding Medicaid to cover an estimated 500,000 Michigan residents without medical coverage can provide mental health care for thousands who without treatment could end up homeless, receiving expensive emergency rooms care or in prison, mental health experts say.

“It is sensible public policy to tap federal funds already set aside to expand preventive and life-saving health care under Medicaid,” said Mike Vizena, executive director, Michigan Association of Community Mental Health Boards.

Expansion represents the best single opportunity to improve access to behavioral health-care services for Michigan’s citizens most in need, he added.

Paul Tarr, a legislative liaison for the Department of Community Health, agreed.

“It is my belief Medicaid reform will definitely help people with mental and physical disabilities,” said Tarr.

Medicaid Expansion: Where Do States Stand?

Excerpt from: Kaiser Health News (click for full article)

 

Stateline reports that seven states could still go either way on pursuing this element of the health law. Kaiser Health News examines Arkansas' approach, viewed by many as a "deal-making compromise" for some states. Meanwhile, Florida lawmakers may be out of time to reach a deal, while some Nebraska lawmakers are attempting to break a logjam. In Ohio, the sparring continues.

Disability Trusts and Medicaid Qualification

Excerpt from: Mullen & Giarusso (click for full article)

 

Medicaid is like the Big Dig—a big, dark hole in the ground—a federal program administered by the state. It covers care in a nursing home for those who qualify. It also provides, among other things, health insurance to the poor of all ages and people with disabilities. In the absence of any other public program covering long-term care, Medicaid is the default nursing home insurance of the middle class. As for home care, Medicaid offers very little.

While Congress and the federal government set out the rules under which Medicaid operates, each state is granted the authority to enforce the rules as it interprets them. In Massachusetts, Medicaid applications are filed in Revere, Taunton, Tewksbury and Springfield; and each processing center interprets the state regulations differently as they wish! A Medicaid application could be approved in 30 days or three years. We find however, about four months to be the norm. You can imagine the anxiety this places on the family whose loved one is in a nursing home.

The Difference Between Patient-Centered Medical Homes and Medicaid Health Homes (In Plain English)

Excerpt from: Health Works Collective (click for full article)

 

In healthcare, it’s common to hear buzzwords thrown around. In the past we have given you a handy guide for navigating the tricky acronyms elder care professionals and caregivers frequently come across.  

Given the complexity of innovation in the healthcare field, it’s sometimes tough to keep up the development of new care delivery models. Recently two community-based care models have garnered a great deal of attention: the patient-centered medical home (PCMH) model and the concept of Medicaid health homes.

While patient-centered medical homes and health homes share some similarities, there are key differences in how each model enhances care for those with chronic conditions and supports aging in place.

Medicaid’s Looming Long-Term Care Crisis

Excerpt from: Hawaii Reporter (click for full article)

 

As we work to rein in wasteful spending and improve retirement security, our nation cannot afford to overlook Medicaid’s long-term care financing crisis.

We’re completely unprepared for the coming “age wave.” More than 15 million Americans will be 85 years or older in 2040. While seven in 10 seniors will need some type of long-term care (LTC) during their lives, only one in 10 has private LTC insurance coverage. Almost 14 million seniors could suffer from Alzheimer’s in 2040, and the annual rate for a private nursing home room continues climbing, reaching $81,030 in 2012.

Research shows many Americans mistakenly believe they have LTC coverage through Medicare when they do not. The misinformation puts their retirement plans at risk. Without change, millions of middle-class baby boomers will turn to a welfare program, Medicaid, to finance these needs.

Kaiser Health News on Controversy Over the Companionship Exemption

Excerpt from: Disability Law (click for full article)

 

Kaiser Health News has a decent piece today on the controversy over the companionship exemption to the Fair Labor Standards Act.  The Department of Labor is preparing rules that would narrow that exemption and extend minimum wage and overtime protections to more home-care aides.  The proposed rule has provoked opposition from home-care agencies, predictably.  It has also provoked opposition from many individuals with disabilities and disability rights organizations, who believe that (without increases in Medicaid reimbursements) it will make personal assistance unaffordable for many people with disabilities and drive them into institutions.  It's always seemed to me that there is room for a compromise here, but folks haven't gotten there yet.

The disability rights group ADAPT focused on this issue during its trip to DC last week; indeed, they shut down all the entrances to the Department of Labor building for a time.  So I was a bit displeased that the KHN article, which is otherwise quite well reported, did not include the voice of a single person with a disability or representative of a disability rights organization.