February 8, 2001
INTEGRATE AND COORDINATE SENIOR HEALTH CARE PROGRAMS
The growing population of seniors will fuel an increasing demand for primary, acute, and long-term health care services. The current health care system for low-income senior citizens is fragmented and does not adequately serve their health care needs. These frail individuals are eligible for some services through Medicare and other services through Medicaid, and often these services are delivered by two different sets of providers. Currently, there is no way to ensure coordination between the two, and in fact, there are enormous fiscal incentives for cost shifting between the programs. Not only does this situation lead to an inefficient use of resources, it can have harmful effects on beneficiary health. Changes are needed to ensure that the most vulnerable citizens receive appropriate, efficient, and effective health care. The single most effective way to improve the system for poor and frail seniors is to fully federalize their health care. Medicaid plays an important role as a safety net for this extremely vulnerable population, but only because Medicare does not effectively serve their needs. This creates a two-tier system for seniors, based largely on income and level of disability. Medicare=s arbitrary service and payment limitations should be re-examined and waived when necessary to ensure that the provision of services for this vulnerable population is direct, efficient, and supports continuity of care. Even under the current structure, common sense reforms that can go a long way towards improving health care for seniors include:
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Providing waiver authority within the Medicare program in order to better coordinate Medicaid/Medicare waivers;$
Providing enhanced federal funding (comparable to the S-CHIP level) to states to help offset the costs of serving this population;
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Allowing states to calculate budget neutrality across federal programs to properly funnel maximum amounts of funds for senior health care;$
Encouraging Medicare to provide case management or care coordination for the dually eligible, with single points of entry and a focus on preventive care; and
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Expanding Medicare to include services vital to frail seniors, such as prescription drugs and home- and community-based long-term care.
Copyright © Center for Medicare Advocacy, Inc. 01/08/2010