Consumers Count: States Should Listen to Dual Eligibles in Designing New Models of Care

By Nathanson, Paul; Richtman, Max | Aging Today, July/August 2012 | Go to article overview

Consumers Count: States Should Listen to Dual Eligibles in Designing New Models of Care


Nathanson, Paul, Richtman, Max, Aging Today


The National Senior Citizens Law Center (NSCLC) and the National Committee to Preserve Social Security and Medicare (NCPSSM) are committed to ensuring that the states' dual eligible proposals contain adequate consumer protections for dual eligibles. The NSCLC, in particular, is engaging advocates nationwide to make sure consumers' concerns are heard and addressed.

As part of the Patient Protection and Affordable Care Act (ACA), states are developing proposals to create new care models, including using Medicaid managed care programs, for many of the 9 million people who qualify for both Medicare and Medicaid. These so-called dual eligibles have legitimate concerns about the future of their healthcare, and are worried their issues will be overlooked in the rush to find a new way to deliver care and slow the cost curve in America's healthcare system.

According to an April 2012 Kaiser Family Foundation issue brief, Medicare's Role for Dual Eligible Beneficiaries (www. kff.org/medicare/upload/8138-02.pdf), dual eligibles account for a disproportionate share of Medicare and Medicaid spending. Dual eligibles comprised 20 percent of the Medicare population, but 31 percent of Medicare spending, and 15 percent of the Medicaid population, but 39 percent of Medicaid spending. They are also more likely to be in fair to poor health, have cognitive, mental or functional impairments, or live in institutions.

The states, together with the Centers for Medicare & Medicaid Services (CMS), have committed to designing personcentered models. We believe that while these models have promise, they also contain great risk. If reforms are implemented with the singular or primary goals of cost savings and administrative efficiencies, they will fail the very people they are designed to help. All states participating in the demonstrations have set up stakeholder processes that are supposed to incorporate consumer input, but flaws in the process have frustrated dual eligibles and their advocates.

If models are to be person-centered, then policymakers must listen to and address valid fears and concerns expressed by people like Rhön Koch and Julie Peck, whose lives will be directly impacted by these potentially sweeping changes.

Listen to the Consumer Base

Koch lives in Michigan and is dually eligible and disabled. Michigan proposes a two-contract approach, with one contract covering all physical health services and long-term supports and services and another covering all behavioral health and developmental disability inpatient and outpatient supports and services. However, Koch says the state's process for gathering input on its proposal left much to be desired. Many Michiganders with disabilities knew nothing about the public stakeholder events, and incredibly, the events often weren't accessible to wheelchairs or by public transportation. Koch also reports that her comments proposing voluntary opt-in enrollment and other consumer protections- many based on NSCLC suggestions- haven't been incorporated in the state's proposal.

Peck is a grandmother, adoptive mother and guardian of a medically complex young man who is dually eligible. Her state, Massachusetts, has already submitted its proposal to CMS; it plans to combine Medicare and Medicaid funding streams to provide integrated care through a managed care organization for dual eligibles younger than 65. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Consumers Count: States Should Listen to Dual Eligibles in Designing New Models of Care
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.