WI: Enacted Budget Gill Grants Governor Broad Powers Over Medicaid 

The recently passed state budget in Wisconsin gives Governor Walker's administration the ability to remake Wisconsin's Medicaid program with relatively little legislative oversight.  The Department of Health and Services is expected to use this power to find $466 million in savings for the next two years.  While an earlier version of the bill required the department to hold public hearings, the budget bill that passed did not include this requirement.  The department will still need to give notice to the Joint Finance Committee of any pending changes and the committee has 14 days to decide whether or not to hold hearings.  Advocates interviewed by the Journal Sentinel were concerned about the abdication of power by elected representatives, the precedent of giving the power to the administration, and the potential changes that will be made to shave $466 million from the program.  Medicaid is jointly financed by the federal government which would also have to approve any significant changes.  While Governor Walker and the legislature both increased funding for Medicaid in the state budget, the increased federal funding provided under the Recovery Act will end at the end of June.  The Center on Budget and Policy Priorities reports that to date, at least 42 states and Washington DC report projected budget shortfalls for FY 2012 totaling $103 billion, with only $6 billion in federal Recovery dollars still available.  The New York Times notes that additional federal stimulus dollars for Medicaid haven't been proposed by Congress or the President, despite a higher number of beneficiaries now than when the extra federal funding was approved in February 2009.  For more information, visit:

Milwaukee Journal Sentinel: "Budget bill gives Walker more power over Medicaid programs"   

Center on Budget and Policy Priorities: "States Continue to Feel Recession's Impact" 

New York Times "As Number of Medicaid Patients Goes Up, Their Benefits Are About to Drop" 

 

 
HHS Informs States On Options To Equalize Spousal Impoverishment Rules  

The Department of Health and Human Services sent a letter earlier this month to state Medicaid directors, informing them of existing options and flexibility to address rules that often result in uneven financial treatment for same-sex couples by Medicaid.  Under current rules, Medicaid can impose liens against the property of a Medicaid beneficiary to recover costs.  However, liens may not be imposed if spouses, children under 21 or who are blind or totally/permanently disabled, and siblings are lawfully residing in the home.  HHS notes that this exclusion represents a "floor" from protection against liens and suggests that states have considerable flexibility in determining a "ceiling" for such protections.  In other words, states could choose to not pursue liens when same-sex spouse or domestic partner beneficiaries continue to lawfully reside in the home.  The letter also addresses asset transfers by Medicaid beneficiaries and explains that state Medicaid policies could address whether or not asset transfer penalties would create an undue hardship on a same-sex spouse or domestic partner.  HHS notes that states also have flexibility around estate recovery and applying liens to pay for the assistance a deceased Medicaid beneficiary received.  States are required to have procedures to waive estate recovery where it would create an undue hardship for the heirs, and states could include same-sex spouses or domestic parents in these procedures. 

A September 2010 Fact Sheet from SAGE, MAP, and CAP, noted that Massachusetts and Vermont extend spousal impoverishment protections to married same-sex couples and that Washington State passed legislation to prevent the recovery of assets transferred to a same-sex or heterosexual domestic partner where a similar asset transfer by a married couple would have been allowed.  The National Resource Center on LGBT Aging recently announced several new resources for LGBT older adults, including an interactive map with state-level legal resources, as well as informative articles on wills, advance directives, and financial power of attorney.   For more information, visit:  

 

Report: Caregivers Forgo $303,880 In Lost Wages, Pension, And Social Security

The National Alliance for Caregiving recently released a report: "Double Jeopardy for Baby Boomers Caring for Their Parents" that details the financial impacts on caregivers who stop working to provide care for a parent. Using data on 1,112 people from the 2008 panel of the National Health and Retirement Study, the authors conclude that the total lost wages, pension and social security benefits for the 9.7 million adult children who are serving as caregivers in the U.S. equals almost $3 trillion. The authors also explain that in a 1994 study, 3% of men and 9% of women reported providing care (defined as 100 hours or more of basic care in the past two years) and these figures more than tripled to 17% of men and 28% of women in 2008. Employees who are aged 50 are older are often in their prime earning years, and the authors suggest that people should consider not only the immediate impact of stopping work to be a caregiver, but also the longer term impacts of reduced retirement and Social Security benefits. For more information, visit:

National Alliance for Caregiving "Double Jeopardy for Baby Boomers..." 

Wall Street Journal "Toll of Caring for Elderly Increases"  

Report: 15 Million Americans Aged 65+ Will Have Poor Transit Access By 2015  

  
A recent report analyzed the adequacy of public transportation in 241 metropolitan areas with a population of 65,000 or more in the year 2000 and found that 11.5 million Americans aged 65 and older experienced poor transit access. The authors project that if the trend to "age in place" continues (a trend preferred by 88% of adults aged 65 or older), then 15.5 million older Americans will experience poor transit access by 2015. This trend is worse in rural communities, where approximately 40% of rural residents lack access to public transportation. While older adults prefer to continue driving, more than 20% of seniors aged 65 and older do not drive at all. The author's suggestions include providing increased, dedicated funding for a variety of public transportation options. They also suggest that transit programs should continue receiving funding from the Highway Trust Fund and state and local departments of transportation as well as transit operators are encouraged to involve seniors and community stakeholders when developing transportation plans. The authors suggest allowing states to retain the ability to flexibly spend their highway funds in order to better tailor their approach. For more information, visit:

Transportation for America: "Fixing the Mobility Crisis Threatening the Baby Boom Generation"    

Madison.com "Biz Beat: Aging Boomers Need Transit, Report Warns" 

Report: Rural Elders In California Face Higher Health Risks

A recent report from the UCLA Center for Health Policy Research finds that the approximately 710,000 Californians aged 65 and older who live in rural areas face unique health challenges. Rural elders are more likely to be overweight or obese (61.3%) as compared to their urban (57.3%) or suburban (54%) counterparts. One in five rural elders do not engage in moderate or vigorous physical activity. In addition, one in five low-income older adults living in rural settings report that they cannot consistently afford enough food for the entire month, a rate that is about twice that of their counterparts in suburban areas. Rural adults also have higher rates of heart diseases and repeated falls.The authors of the study provide policy recommendations, including senior walkability plans and using the internet for in-home monitoring, patient self-management, and online prescription ordering. They also suggest incentivizing primary care providers to work in rural areas, improving/expanding transportation services, and providing federal subsidies and loans for rural grocery stores and other food outlets. For more information, visit:

UCLA: "Out of reach? Rural elders have high rates of obesity, diabetes, heart disease"   

Study: Rehospitalizations Reduced With Intervention  

The June issue of the Journal of the American Geriatrics Society featured a study which used a three-pronged intervention approach to reduce avoidable rehospitalizations for patients being discharged from a skilled nursing facility (SNF).  The intervention includes a standardized template for physician admissions procedures, palliative care consultations for patients with three or more hospital admissions in the past 6 months, and root-cause analysis conferences for patients transferred back to the hospital that are conducted on a bi-monthly basis.  The intervention took place at a SNF with 50 beds, and included 862 patients (baseline) and 863 patients (who received the intervention) who were admitted to the SNF from acute care hospitals between June 2008 and May 2010.   For patients who received the intervention, readmissions to acute care declined (from 16.5% to 13.3%), and patients were more likely to die at the SNF in accordance with their wishes than to be transferred out to a hospital.  Discharges to homes also increased from 68.5% to 73%, and discharges to long-term care dropped to 11.5% from 13.8%.  "The change in discharge disposition observed between the two periods, we believe, reflects an improvement in patient outcomes," says lead author Randi E. Berkowitz, M.D. For more information, visit: 

A recent report from PHI outlines challenges and opportunities to improving the quality of direct care provided to care recipients while also improving the quality of direct care jobs. Citing the 4.5 million elders and people with disabilities who currently receive care in the U.S., the 3.2 million direct-care workers who provide these services, and the expected growth in need for this workforce, the author outlines a number of challenges and strategies. One of the key issues is compensation for direct care workers- the median hourly wage in 2009 was $10.58 as compared to the median for all U.S. workers of $15.95. In addition to low wages, direct care workers also face a lack of hours (48% in 2009 worked less than full-time year-round), and lack access to health care, with an estimated 900,000 direct-care workers in 2009 lacking health care coverage. The author outlines nine elements of quality jobs as well as essential elements of quality care for consumers, including self-direction, keeping dignity and privacy, and individualized care. For more information, visit: 

 

Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards

Family Caregiver Alliance recently announced that applications are now available for the fourth annual Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards. The awards are given in three categories, Creative Expression, Diverse & Multicultural Communities, and Policy & Advocacy. Each of the three award recipients receive a $20,000 award, and applications are invited from non-profits, government agencies, and universities. The application deadline is August 15th, 2011. For more information or to view the application, visit:

FCA: "Rosalinde Gilbert Awards Application"

Husband Allegedly Fired For Requesting Flexible Schedule To Care For Wife With Cancer 

An ABC News article focused on a man who is a caregiver for his wife with lung cancer and who was allegedly fired for requesting a more flexible work schedule to enable him to provide care to his wife. Carl Sorabella, an accountant for a real estate company in Massachusetts, had worked for the company for 14 years, and had received a raise this past November. According to Sorabella, he requested a flexible schedule so that he could accompany his wife to medical appointments, and the following week he received notice that he was fired. David Frank, a legal analyst with Lawyers Weekly, was interviewed for the story and explained "This is not an unprecedented situation," and cited the fact that the Family Medicaid Leave Act (FMLA) only covers employers with 50 or more employees. Sorabella estimated that his company employs 20 people. An article in the Chicago Tribune this week highlighted the financial and legal challenges that people with cancer (and their caregivers) often encounter. The article also profiled the Cancer Legal Resource Center (CLRC), a joint initiative between the Disability Rights Legal Center and Loyola Law School Los Angles. The program operates a national toll-free-assistance line (866-THE-CLRC) and is also sponsoring three conferences this summer (in Chicago, Washington, DC, and Ann Arbor, Michigan) that will focus on cancer-related legal issues. For more information, visit:

ABC News "Man Says He Was Fired After Telling Employer His Wife Has Cancer"

Chicago Tribune "Cancer patients get help through financial, health care mazes"

Cancer Legal Resource Center