Articles Posted in Medicaid Planning

When Medicare was expanded in 2003, the expansion that established prescription drug coverage was called a “promise, a solemn promise, to America’s seniors.” Part D Medicare officially took effect in 2006, but still some seniors were afraid of falling into the infamous “doughnut-hole” coverage gap.

Initial Benefits of Part D

In Part D’s first few years, national data has shown that the program had helped seniors make progress with their prescription drugs. Overall, out of pocket costs decreased for medication, seniors took their medication more regularly, and were less likely to forego basics like food or heat in order to afford for their prescriptions.

The New York Medicaid system is the primary means of providing long-term care to many seniors in the state. However, the system’s popularity led to financial strains, and public officials have worked for years to address rising costs and budget challenges. The most popular large-scale change to the program pushed by reform advocates is referred to as “managed care.”

The idea of managed care is to move away from paying service providers per specific task provided and instead compensate them a flat fee for each resident–regardless of what care the resident needs. The idea is to eliminate the company’s incentive to provide care that is not needed simply to increase their reimbursement. By providing a flat fee per resident, caregivers are incentivized to provide efficient, quality care.

Purging “Unprofitable” Clients?

As the first wave of healthcare insurance enrollment ends as part of the Affordable Care Act, observers are quick to comment on the changes enacted by the law. In addition to millions who took advantage of insurance sold in private marketplace exchanges, there has also been a significant increase in Medicaid participants–both in New York and nationwide.

According to a New York Times report last week, across the country there are now over 62 million Americans receiving some Medicaid support. The increase is more targeted in states like New York that specifically took advantage of options in the Affordable Care Act that allow for expansion of the program.

Importantly, much of the discussion about healthcare exchanges and Medicaid expansion refer to general health insurance coverage–not necessarily care that includes long-term support for the elderly.

We are in the midst of significant changes to the New York Medicaid system. The critical state-federal program serves as a lifeline for many residents–including those in nursing homes. As part of President Obama’s healthcare overhaul, Medicaid is expanding, opening opportunities to more residents than ever before. New York has been cited as a model for that expansion, as our state has the most robust system in the country.

At the same time, however, with expansion comes increased scrutiny on exactly how each Medicaid dollar is spent. Both state officials and federal regulators are focusing on cutting out fraud and otherwise maximizing the value of funds. While this may seem like only a concern of policymakers, these changes will also trickle down and directly affect New York residents who rely on the system. As oversight changes, there may be alterations to the Medicaid application process and new rules about what benefits a resident can receive as part of the system.

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