Archive for the ‘Medicare and Medicaid’ Category

Family Support in Graying Societies

May 21, 2015 Comments off

Family Support in Graying Societies
Source: Pew Research Center

The United States is turning gray, with the number of people ages 65 and older expected to nearly double by 2050. This major demographic transition has implications for the economy, government programs such as Social Security and families across the U.S. Among adults with at least one parent 65 or older, nearly three-in-ten already say that in the preceding 12 months they have helped their parents financially. Twice that share report assisting a parent with personal care or day-to-day tasks. Based on demographic change alone, the burden on families seems likely to grow in the coming decades.

Germany and Italy, two of the “oldest” nations in the world, after only Japan, are already where the U.S. will be in 2050: a fifth of the population in each country is age 65 or older. Compared with the U.S. today, a higher share of adults in Germany and Italy report helping their aging parents with basic tasks, and more in Italy have also provided personal care. However, in both countries, fewer adults than in the U.S. say they have provided financial assistance to their aging parents.

Health-Care Coverage for Youth in Foster Care—and After

May 13, 2015 Comments off

Health-Care Coverage for Youth in Foster Care—and After
Source: Child Welfare Information Gateway

This issue brief reviews the eligibility pathways for children and youth in foster care to receive Medicaid or other health-care coverage and looks at some of the newer benefits now mandated through the Patient Protection and Affordable Care Act (ACA), especially those for older youth in or formerly in foster care.

High Interest GAO Report — Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence

April 29, 2015 Comments off

Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence
Source: Government Accountability Office

Advance directives, such as living wills or health care powers of attorney, specify—consistent with applicable state law—how individuals want medical decisions to be made for them should they become unable to communicate their wishes. Many individuals receive medical care from Medicare and Medicaid funded providers during the last 6 months of life, and may benefit from having advance directives that specify treatment preferences. According to IOM, advance directives are most effective when part of a comprehensive approach to end-of-life care called advanced care planning.

GAO was asked to review information related to advance directives. This report examines (1) how CMS oversees providers’ implementation of the PSDA requirement; (2) what is known about the approaches providers use and challenges they face to inform individuals about advance directives; and (3) what is known about the prevalence of advance directives and how it varies across provider types and individuals’ demographic characteristics. To do this work, GAO reviewed CMS documents and survey data reported by state survey agencies into CMS’s Certification and Survey Provider Enhanced Reporting system about covered providers’ implementation of the PSDA requirement. GAO also conducted a literature review of peer reviewed articles and federal government reports. In addition, GAO interviewed CMS officials and stakeholders representing providers and individuals likely to benefit from advance directives.

State Discretion Over Medicaid Coverage for Mental Health and Addiction Services

April 17, 2015 Comments off

State Discretion Over Medicaid Coverage for Mental Health and Addiction Services
Source: Psychiatric Services

Approximately one-third of adults who enroll in Medicaid because of a disability have a serious mental illness. Arguably, this population stands to benefit from insurance coverage that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA). The MHPAEA and the Affordable Care Act (ACA) do not guarantee such coverage for this beneficiary group; however, they provide a variety of mechanisms by which states may provide parity-compliant coverage for mental health and substance use disorder treatment. This column explains key interactions between the MHPAEA, the ACA, and the Medicaid program that permit states to determine whether and how to provide parity-consistent coverage to beneficiaries with disabilities.

Medicare’s Income-Related Premiums: A Data Note

April 2, 2015 Comments off

Medicare’s Income-Related Premiums: A Data Note
Source: Kaiser Family Foundation

A pressing debate in current Medicare policy circles is how to cover the cost of repealing and replacing Medicare’s Sustainable Growth Rate (SGR) formula for physician payments. As part of this discussion, some policymakers have proposed to increase Medicare premiums for higher-income beneficiaries—an idea that also has been raised in the context of proposals to reduce federal spending. Under current law, most Medicare beneficiaries pay the standard monthly premium, which is set to cover 25 percent of Part B and Part D program costs, while the relatively small share of beneficiaries (around 6 percent in 2015) with incomes above $85,000 for single people and $170,000 for married couples are required to pay higher premiums for Medicare Part B and Part D—ranging from 35 percent to 80 percent of program costs, depending on their incomes.

Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees

April 2, 2015 Comments off

Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees
Source: Employee Benefit Research Institute

Executive Summary

  • This study separates the more predictable health care expenses in retirement for older Americans (ages 65 and above) from the less predictable ones. Based on utilization patterns and expenses, doctor visits, dentist visits and usage of prescription drugs are categorized as recurring health care services. Overnight hospital stays, overnight nursing-home stays, outpatient surgery, home health care and usage of special facilities are categorized as non-recurring health care services.
  • The data show that recurring health care costs remain stable throughout retirement. The average annual expenditure for recurring health care expenses among the Medicare-eligible population was $1,885. Assuming a 2 percent rate of inflation and 3 percent rate of return, a person with a life expectancy of 90 would require $40,798 at age 65 to fund his or her recurring health care expenses. This does not include recurring expenses like insurance premiums or over-the-counter medications.
  • Usage and expenses of non-recurring health care services go up with age. Nursing-home stays in particular can be very expensive. For people ages 85 and above, the average and the 90th percentile of nursing-home expenses were $24,185 and $66,600 during a two year period, respectively.
  • Nursing-home stays, home health care usage, and overnight hospital stays are much higher in the period preceding death. More than 50 percent in every age group above age 65 received in-home health care from a medically trained person before death. For those ages 85 and above, 62.3 percent had overnight nursing-home stays before death and 51.6 percent were living in a nursing home prior to death.
    Some recurring and non-recurring expenses were also much higher before death.
  • Usage of recurring health care services generally go up with income and usage of non-recurring health care services—except outpatient surgery and special facilities—goes down with income.
  • The top income quartile spent significantly more on nursing-home and home health care expenses than the rest. This could be a result of Medicaid coverage for the lower-income, lower-asset groups.
  • Women above 85 have significantly higher nursing-home usage than men. The rest of the differences between men and women are small.

Medicaid and Intergenerational Economic Mobility

April 2, 2015 Comments off

Medicaid and Intergenerational Economic Mobility
Source: Institute for Research in Poverty (University of Wisconsin)

Previous research demonstrates that the Medicaid expansions of the 1980s and 1990s had lasting effects on the health, education and labor market outcomes of children. Yet to date there has been no direct test of the effect of Medicaid expansions on intergenerational economic mobility. Using new commuting zone level estimates of economic mobility for children born between 1980 and 1993, we exploit the uneven expansions of Medicaid eligibility across states to isolate the causal effect of this policy change on mobility outcomes. Regression models using simulated state-year specific eligibility criteria as an instrument for expanding coverage demonstrate that increasing the proportion of women aged 15–44 eligible for Medicaid is associated with a reduction in the correlation between the income ranks of parents and their children in adulthood. We further find the Medicaid expansions increased the probability that children born to low-income parents experience absolute upward mobility. These findings suggest early exposure to health insurance may be a key policy lever for promoting intergenerational mobility and economic opportunity.


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