Kaiser Health News profiled Oklahoma's new online enrollment Web Site for Medicaid and suggested that the process (11 minutes) was as quick as setting up a Netflix account.   Oklahoma is the first state to fully automate enrollment- meaning people can apply online and receive a decision about whether or not they qualify for SoonerCare (OK's version of Medicaid) online.  The move is important because of the approximately 16 million Americans who are slated to become eligible for Medicaid under the Affordable Care Act in 2014.   The state predicts that at least 250,000 Oklahomans will become new enrollees when the provision takes effect.   Kaiser Health News notes the irony in Oklahoma's new capability at the same time that the state turned down a $54.5 million federal grant to develop its state health exchange.  A June Kaiser Foundation report found that 32 states offer an online, publicly-accessible application for Medicaid and/or CHIP that could be submitted electronically while 18 states allow online renewals.  

On a related note, a mother announced a lawsuit against the city and county of Denver over a benefit system malfunction which incorrectly told a Walgreens pharmacy that her son did not qualify for Medicaid in 2009. According to the Denver Post, despite having letters from the agency attesting to his eligibility, his mother couldn't get his asthma prescription filled for several months because the computer system indicated to the pharmacy that he was ineligible.  Her son died in 2009 after complications from an asthma attack.  Colorado's re-vamp of six separate benefit computer systems into one system began in 2002 and has been a rocky transition with lawsuits and settlements over backlogs, wrongful terminations, and incorrect eligibility determinations. For more information, visit:

 

 
Brief Explains How FMAP Is Calculated And Potential Impact of ACA

A paper from the Kaiser Commission on Medicaid and the Uninsured provides an overview of the Federal Medical Assistance Percentage (FMAP), how the formula is calculated, and potential changes as more people become eligible for Medicaid under the Affordable Care Act.  FMAP is the specific percent that the federal government uses in calculating its share of the cost of Medicaid in each state and is based on each state's per capita income for the past three years relative to the U.S. average.  Because the income is calculated using data from the past three years, there is a lag in accounting for economic downturns.  The formula gives relatively poor states a higher share of federal money than wealthier states.  On average, the federal government pays about 57% of the cost of Medicaid benefits while states pay 43%.  For more information, visit:

Kaiser Commission on Medicaid and the Uninsured: "An Overview of Changes in the Federal Medical Assistance Percentages (FMAPs) for Medicaid" 

 
HHS: 17 Million Americans Received Preventive Services

The Department of Health and Human Services announced earlier this month that 17 million people have received free preventive services this year through Medicare while 900,000 Medicare beneficiaries in the donut hole received 50% discounts on their prescription drugs.  In addition, year to date, over one million Americans with original Mediare have received an Annual Wellness Visit.  The cost of the average Medicare prescription drug plan premium is scheduled to be about $30 in 2012, a slight decrease from $30.76 in 2011.  The release also includes links to state-by-state information. For more information, visit:

HHS Press Release: "Medicare prescription drug premiums will not increase, more seniors receiving free preventive care, discounts in the donut hole" 

CMS: "Beneficiaries Utilizing Free Preventive Services by State, Year-to-Date 2011"  

 
AHRQ Accepting Comments On Draft Report On Case Management For Adults With Medical Illness And Complex Care Needs

AHRQ is accepting comments on a draft report on case management for adults with medical illness and complex care needs.  The draft report evaluates case management as an intervention strategy for chronic illness management and summarizes existing evidence related to how case management can improve patient-centered outcomes, quality of care, and resource utilization.  Comments are due by August 23, for more information or to provide feedback, visit:

AHRQ   

 

Three GAO Reports: LTC Insurance, Nursing Home Ownership, And Guardians

The GAO recently released three reports on issues important to family caregivers, including an analysis of a long-term care premium increase in the federal government's long-term care insurance program, an analysis of private investor ownership of nursing homes, and a review of court-appointed guardians in Social Security, the Veterans Administration, and state courts.

The first report analyzes an increase of up to 25% in premiums for 66% of the enrollees in the Federal Long Term Care Insurance Program that was implemented shortly after John Hancock Life Insurance Company was awarded a seven-year contract to administer the program.  The report discusses the difficulty in pricing long-term care insurance, an issue that has led many long-term care insurers to raise monthly premiums and/or to exit the market altogether.

The second report analyzes nursing homes that were acquired by private investment (PI) firms and whether or not this ownership affects deficiency rates on state surveys, nurse staffing levels, and financial performance.  The authors find that on average, PI and other for-profit homes had more total deficiencies than nonprofit homes before (2003) and after (2009) acquisition. While the reported total nurse staffing ratios (hours per resident per day) were lower in PI homes, there were higher numbers of registered nurses in PI homes than in other homes.  

The third report examines guardians who are appointed by the Social Security Administration, Veterans Affairs, and state courts and compared the screening procedures, laws, and information sharing between these three programs.  The GAO suggests that there is room for improvement in guardianship monitoring by state courts and information sharing between the three entities.  For more information, visit:

GAO: "Long-Term Care Insurance: Carrier Interest in the Federal Program, Changes to Its Actuarial Assumptions, and OPM Oversight" 

GAO: "Nursing Homes: Private Investment Homes Sometimes Differed from Others in Deficiencies, Staffing, and Financial Performance" 

GAO: "Incapacitated Adults: Oversight of Federal Fiduciaries and Court-Appointed Guardians Needs Improvement" 

Report: Spending For Hospice Care For Nursing Home Residents Has Increased 70% Since 2005

  
A July report from the Inspector General at Health and Human Services examines the growth in hospice care in nursing facilities and suggests that "Some hospices may be seeking beneficiaries with particular characteristics, including those with conditions associated with longer but less complex care."  The report recommends that CMS monitor hospices that depend heavily on nursing facility residents and to modify the payment system for hospice care in nursing facilities.  CMS concurred with both recommendations and with the suggestion that the current payment structure may incentivize hospices to seek out beneficiaries in nursing facilities who "often receive longer but less complex care."   USA Today noted that the two largest for-profit hospice companies, Vitas and Gentiva, have spent $1.1 million on lobbying thus far this year, with a focus on a bill by Senator Ron Wyden (D-OR) that would require CMS to test a new payment system for two years.  Medpac, which advises Congress on Medicare issues, expressed concerns in its March report on Medicare about the increase in longer hospice durations (suggesting that some patients may not meet the six month rule) and potential conflicts of interest between some nursing facilities and hospices.  For more information, visit:

Office of Inspector General: "Medicare Hospices That Focus on Nursing Facility Residents" 

USA Today: "Hospice lobbyists battle over Medicare payment system"

Medpac: "Report to the Congress: Medicare Payment Policy" (Chapter 11: Hospice) 

Report: National Median Hourly Wage For Personal Care Aides Declined in 2010

LPHI PolicyWorks released its State Chart Book on Wages for Personal Care Aides earlier this month.  The authors find that the national median hourly wage for Personal Care Aides (PCA's) declined from $9.46 in 2009 to $9.44 in 2010, driven by a drop in wages in 17 states.  During the ten year period from 2000 to 2010, 23 states and the District of Columbia showed increases in real median wages, however, only four states showed annual increases of at least two percent.  Thirty-four states reported average hourly wages that fell below 200% of the Federal Poverty Level ($10.42 an hour) in 2010, thus potentially qualifying workers for state and federal benefit programs.   A federal bill has been introduced, the Direct Care Job Quality Improvement Act, that would eliminate the companionship exemption in the Fair Labor Standards Act that currently exempts home care workers from receiving a guaranteed minimum wage and overtime.  The report by PHI includes state-by-state data.  For more information, visit: 

PHI: "State Chart Book on Wages for Personal Care Aides, 2000-2010" 

FCA Legislation Center: "Direct Care Job Quality Improvement Act"   

Study: Caregivers And Relatives Perceive Care Differently

A recent study interviewed 266 pairs of primary caregivers and their loved one with mild to moderate dementia and the results appear in the August issue of the Gerontologist.  Each person was interviewed separately about five values: autonomy, burden, control, family, and safety.  The authors found that adult children underestimated the importance of the five core values to their parents with dementia and that the discrepancies were associated primarily with the caregivers' beliefs about their loved one's involvement in decision making.  They conclude that it is important for caregivers to gain a more accurate idea about their loved one's values and preferences, perhaps in the earlier stages of dementia, since caregivers will become the surrogate decision makers as the disease progresses.  For more information, visit:

PennState Release: "Caregivers and their relatives disagree about care given, received" 

Gerontologist: "Understanding Discrepancy in Perceptions of Values: Individuals With Mild to Moderate Dementia and Their Family Caregivers" (abstract is free) 

FCA Fact Sheet: "Caregiver's Guide to Understanding Dementia" 

Study: Hospitalists Associated With Shorter Hospital Stays, Increased Medicare Costs

A study in the August issues of the Annals of Internal Medicine analyzed the increasing role of hospitalists (doctors who work full time in hospitals) and found that for patients who were cared for by hospitalists, their lengths of stay were about a half day shorter and led to charges for the hospital that were $282 lower.  However, Medicare costs in the 30 days after discharge were $332 higher, patients were less likely to be discharged to home, and were more likely to have ER visits and readmissions after discharge.  The results were based on a 5% national sample of 58,000 enrollees in Medicare parts A and B with a primary care physician who were cared for by their primary care physician or by a hospitalist during a medical hospitalization from 2001 to 2006.  In a posting about the results on The New Old Age, Jane Gross suggests that generalizing the study's finding to the roughly 25% of Medicare beneficiaries cared for by hospitalists equates to hospital savings of around $1 billion a year, but that an equal or greater amount is being paid for by taxpayers in the form of higher readmissions.  For more information, visit: 

Annals of Internal Medicine: "Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study" (abstract is free) 

New York Times: "Do Hospitalists Save Money?" 

FCA Fact Sheet: "Caregiver's Guide to Discharge Planning" 

  

Rosalinde Gilbert Innovations In Alzheimer's Disease Caregiving Legacy Awards

The application deadline for the fourth annual Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards has been extended to September 16th. 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 new application deadline is September 16, 2011. For more information or to view the application, visit:

FCA: "Rosalinde Gilbert Awards Application"

Articles Focus On Caregiving Issues For Baby Boomers

Three recent articles focused on issues that adult children who are caregivers often face with their parents:  

In Forbes Magazine, Carolyn Rosenblatt, an elder law attorney explains the importance of getting a diagnosis, which can help explain dementia-like behavior and ensure that medication interactions, infections, stroke, or even dehydration aren't to blame for memory or behavior problems.  Using a friend's dad as an example, she provides four recommendations when a parent shows troubling behavior.  They include getting a checkup from a reliable MD, preferably a neurologist who works with aging patients, locating and updating estate planning documents (while people are still competent to sign documents), planning ahead for possible care needs, and discussing the parent's situation with all of the family members during a family meeting.

An Associated Press/Washington Post article highlights a trend of adult children remodeling their homes to create spaces for their parents to move in with them.  The National Association of Home Builders reports that 62% of builders they surveyed were working on a home modification related to aging in 2010.  A builder interviewed for the story suggested that involving the parents in the conversation with a builder will make a transition smoother.  A company in Indianapolis, called Next Door Garage Apartments, can convert a two-car garage into a complete apartment within ten days for $35,000.  A woman whose mother-in-law came to live with them explained that the arrangement works well because her mother-in-law doesn't need complex medical care, the family got along well before living together, and the mother-in-law pays for her portion of utilities each month, thus retaining some independence.

A Sacramento Bee article addresses the importance of communication between adult children and their parents around long-term care issues, including end-of-life health care preferences and finances.  Barbara Gillogly, a gerontology professor, explains that while conversations are awkward, "If people won't talk about it, they need to understand that at some point, somebody else will make those decisions for them... Do you want the state to make those decisions? Do you want your adult children to make their best guess? Or do you want them to know?"  For more information, visit:

Forbes: "The Danger Of Your Aging Parent Covering Up Dementia"

Associated Press/Washington Post: "When an aging parent moves back in: tips for a smooth transition" 

Sacramento Bee: "Never too early to discuss end-of-life issues with parents"