Medicare Watch

Why Medicaid Matters to People with Medicare

While many people know Medicaid for the assistance it provides to low-income children and their families, lesser known is the financial assistance that Medicaid provides for people with Medicare, including coverage of out-of-pocket costs associated with Medicare and long-term care. Currently, Medicare does not provide coverage for long-term care, so many people with Medicare rely on Medicaid to access these types of services. According to a recent report released by Families USA, 16 million older Americans and people with disabilities rely on Medicaid for support, and Medicaid is the primary payer for an estimated 63.6 percent of all nursing home residents. In addition, more than three million older adults and people with disabilities rely on Medicaid to help them afford the long-term care services and supports they require outside of an institutional setting, enabling them to stay in their homes and communities. With average nursing home costs for private rooms reaching over $75,000 per year, according to a study by Genworth, a long-term care insurance provider, Medicaid is essential for many who would otherwise be unable to afford long-term care. Furthermore, Medicaid also provides supplemental insurance to Medicare, covering out-of-pocket costs and additional coverage for Medicare consumers with limited incomes. In fact, about 40 percent of Medicaid dollars are spent on people with Medicare and Medicaid, who are also known as dual eligibles. 

For this reason, Medicare cuts included in both the budget recently passed by the House of Representatives and in other deficit-reduction proposals are not the only changes that impact older Americans and people with disabilities; cuts to Medicaid also could drastically affect the financial security and health of Medicare consumers and their families. Cuts to Medicaid accomplished through “block grants” or “spending caps” that limit the amount of Medicaid funding available to states would lead to more restrictive Medicaid eligibility rules, meaning fewer people would qualify, and to cuts to services such as Medicaid home- and community-based service programs.

Read AARP’s Public Policy Institute’s reports “The High Cost of Capping Federal Medicaid Funding” and “Medicaid: A Program of Last Resort for People Who Need Long-Term Services and Supports.”

Read the Medicare Rights Center’s “Medicare and Medicaid: Essential Partners for Older Americans and People with Disabilities.”

Read Families USA’s report “Cutting Medicaid: Harming Seniors and People with Disabilities Who Need Long-Term Care.”

Read the National Senior Citizens Law Center’s report “Medicaid Block Grants: Attacking the Safety Net for Low-Income Older Adults.”

Share your story about how Medicaid helps you and your family access long-term care.

Alignment Initiative Promotes Care Coordination for Dual Eligibles

A new effort to better coordinate care for people with Medicare and Medicaid, who are commonly known as dual eligibles, was announced this week by the Medicare and Medicaid Coordination Office (MMCO) at the Centers for Medicare & Medicaid Services (CMS). Coined the “Alignment Initiative,” the effort was launched by MMCO, formally called the Federal Coordinated Health Care Office, and was made possible by the Affordable Care Act (ACA). The Alignment Initiative will seek to ensure more seamless access to care by identifying and aligning coverage rules that differ under Medicare and Medicaid and that thus cause fragmented care for dual eligibles. CMS released a proposed rule that outlines several broad categories where improvements can be made, including coordinated care, fee-for-service benefits, prescription drugs, cost-sharing, enrollment and appeals, and that identifies the specific areas where better alignment may be achieved. For example, Medicare and Medicaid coverage rules for Durable Medical Equipment (DME), such as wheelchairs, differ. These different standards may lead to gaps in coverage while Medicare and Medicaid determine which program is responsible for payment. 

In addition, MMCO announced that they would provide states with better and timelier access to Medicare claims data for the dual-eligible population. Claims data, such as Medicare physician, hospital and prescription drug use, will help states to identify high-risk individuals, create a patient profile and determine appropriate interventions through better coordinated care. Early intervention and better care planning can not only help improve the health of the population–60 percent of dual eligibles have multiple chronic conditions–but can also create savings for both Medicare and Medicaid. Although they comprise only 15 percent of Medicaid recipients, dual eligibles account for almost 40 percent of the program’s cost.

Read the Department of Health & Human Services press release on the Alignment Initiative.

Read the proposed rule on Medicare and Medicaid alignment.

Medicare Reminder

If you are eligible for Medicare and have a low income, you may qualify for help from certain Medicaid programs in your state. In general, your state will have more than one program that can help people who are eligible for Medicare.

Whether you qualify for a Medicaid program will depend on the standards your state sets regarding:

• your income (for example, money you take in from Social Security payments or wages that you earn);
• your assets (resources such as checking accounts, stocks and some property); and
• if you need long-term care, the “functional eligibility” or “level-of-care” standards for assessing your need for help with activities of daily living (for example, toileting, bathing, dressing) and your need for nursing care.

Medicaid programs can help pay for Medicare’s costs and for services that Medicare does not cover.

Learn more about Medicaid programs you might qualify for at www.MedicareInteractive.org.

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