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View Diary: Medicaid support among moderate Senate Dems weak (28 comments)

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  •  Elderly Facing Nursing Home Need (2+ / 0-)
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    CherryTheTart, NCPSSM

    and their families.

    Same folks who put Medicare out of harm's way.  They may not be there now,  but I guarantee they know someone who has.  

    Over 40% of people over 65 will end up needing nursing home care sometime during their lifetime even more will need some kind of long term care (including home and community based services like assisted living facility or home health nursing).  

    The elderly in raw numbers make up only 10% of Medicaid reciplients  but account for 25% of the costs.

    The disabled make up only 15% of recipients but account for 42% of the cost.

    Low income adults below 65 make up 25% by the numbers but only 12% of the cost.

    A small group, 5% of recipients, account for over 50% of the costs.

    Medicaid pays for 7 out of 10 nursing home residents and 43% of all long term care including home and community based alternatives.  

    Private insurance pays less than 1% of nursing home care.

    Some studies estimate that cash out of pocket (ie uninsured and not yet poor enough to qualify for Medicaid) already pays for up to 37% of nursing home costs.  

    Since the recession, over 7 million more people have enrolled in Medicaid.  The recession and collapse in value of many retirement accounts and house values has and will disproportionatly impact the elderly who were on the cusp of selling their home and moving into a long term care facility (voluntarily or driven by need.)

    State flexibility is another term for ability to use federal Medicaid dollars to subisdize their state's general fund and avoid the need to live within their own state's means.  

    The federal financing of this program already pays a greater share (Federal Financial Participation) in states with lower average incomes.  It varies from a minimum of 50% up to 75%.  

    The 2009 Stimulus (ARRA) bailed out States by picking up a greater share of that financing on the condition that States not take the money and run by taking the money but cutting back on services ("maintenance of effort" requirements.)  That's now gone or going away.  

    The 2014 expansion of Medicaid, making the poverty level from well below the national poverty threshold and increasing the coverage to those 1/3 above that income threshold was also conditioned on that same prudent principle.  (Much of the cost of that expansion is picked up by the federal financing.)

    If the FFP match was included as part of the Block Grant program, States with FFP of 66% (Hi There Red States) and higher would lose $2 in federal money for every $1 cut in State spending.  Block grants would likely allow them to cut state spending without experiencing that leveraging affect.

    If we, all of us, as federal tax payers are going to help fund this program, we have a right to know it is meeting basic standards in quality, coverage and integrity.  

    If, by removing these safeguards as part of a magic "Block Grant" approach, the GOP predicts massive savings, where are those savings coming from?  

    Ingenuity and flexibility are not the magic wands the GOP would like to pretend.  

    The 'savings' will come not from fat but from meat and bone as both coverage and quality are cut to squeeze within the available money.

    Are we going to allow States to keep additional Federal money while cutting back on the programs they offered to be eligible for that level of Block Grant?

    If a State had included all available options under Medicaid services in 2007, takes all the enhance revenue from the Federal government but cuts back its services covered to the bare mininimum currently covered or some even more austere level allowed under the Republican proposal, how is that fair?

    Can states cut back their services but still get the same level of federal money, shifting the money to cover other budget needs not within the Medicaid program?   By doing so, will we be cross-subsidizing their other state expenditures and allowing them to avoid the "evil" of tax increases on their state citizens?  

    Given the Republican aversion to "entitlement" programs, will the States be able to cap the number of days (or $) that any nursing home resident is allowed under Medicaid? Will nursing home residents face eviction (discharge) once they've hit their State Limit Of Care?  (Or as implied in Ryan's version of The Road, be encouraged to get out of their welfare hammock and get a job?)

    If you're confident that State's would handle this new freedom and "flexibility" in a prudent and compassionate manner, you've been absent from this past year's budget hearings in state capitals around the Country.  

    As a Federal Taxpayer, I have no interest in funding the "no new taxes pledges" of red states already getting a disproportionate share of the federal funding under this program because of their lower average income per capita.  

    The Kaiser Foundation has some excellent resources on this issue (and many others) here:

    House Republican Budget Plan: State-By-State Impact of Changes in Medicaid Financing  (Includes a State-by-State comparison of current law including ObamaCare (ACA) vs the Ryan/GOP Budget plan and current law with ObamaCare (ACA) repealed. - Table 1 - Pg 14/20)

    Top 5 Things To Know About Medicaid

    FEDERAL CORE REQUIREMENTS AND STATE OPTIONS IN MEDICAID:CURRENT POLICIES AND KEY ISSUESApril 2011

    Implications Of A Federal Block Grant Program For Medicaid

    Medicaid and Block Grant Financing Compared - Issue Brief - 2004

    Federal Dollars and State Flexibility: The Debate Over Medicaid's Future - 1995

    Here's a quick primer for those still trying to figure out which is MediCARE and which is MediCAID.

    Medicare and Long-Term Care:
    While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the care you get. Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called "custodial care". Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary. You may have to pay some of the costs. For more information about Medicare Advantage Plans, look at the Medicare Personal Plan Finder.

    Medicaid and Long-Term Care:
    Medicaid is a State and Federal Government program that pays for certain health services and nursing home care for older people with low incomes and limited assets. In most states, Medicaid also pays for some long-term care services at home and in the community. Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources.

    We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

    by Into The Woods on Tue Jun 14, 2011 at 04:53:25 PM PDT

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