A new proposal by the Patrick Administration, funded through the Affordable Care Act , will coordinate health and long term care services for those aged 21 to 64 who receive both Medicare and MassHealth , the state’s Medicaid program. Newly created “Integrated Care Organizations,” will be responsible for making sure these individuals receive the services that address their full range of needs through one access point. The proposal may take effect as early as this Fall.
Younger disabled persons between the ages of 21 to 64 who are served by both Medicare and MassHealth (dual eligibles) generally have complex care needs. They are among the poorest, sickest, and also costliest of all Medicare patients. Navigating between the two separate programs and systems to get the care they need leaves many vulnerable to “falling through the cracks” and getting care that is not adequate.
What’s the Catch?
AARP Massachusetts supports the overall goal of improving access, quality and cost of care, but seeks to improve consumer protections in the Administration’s proposal, including the creation of:
- a truly voluntary, active enrollment
- a strong appeals process
- continuity of care
At a public hearing, held in January, AARP outlined a series of recommendations to address these and other specific parts of the proposal.
What about Seniors?
As this project moves forward, those aged 65 and older enrolled in both Medicare and MassHealth could be affected – specifically those participating in Senior Care Options , a voluntary managed care plan for this group.
Two-thirds of all individuals receiving care from both Medicare and MassHealth are over age 65, and 60 percent have multiple chronic conditions.
AARP has called on the Administration to make sure:
- Any integration of benefits for individuals enrolled in Medicare and MassHealth must meet the needs of this group, with the goal of improving quality of care and quality of life.
- Individuals should have access to the benefits that best meet their individual needs and preferences.
- All efforts should support and provide incentives for home- and community based services first, as opposed to institutional care.
- Acute care, physical and behavioral care, long term services and supports and other social services must be coordinated to meet the holistic need of the individual and his or her caregiver.
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