Major changes needed in Medicaid, says Center for Retirement Research

Here’s a thought-provoking new report: Medicaid and Long-Term Care: How Will Rising Costs Affect Services for an Aging Population?, Howard Gleckman, Center for Retirement Research at Boston College, April, 2007.

From the conclusion:

The goal of government long-term care policy should be to provide the best possible quality of life for the elderly and disabled in the most cost-effective way. It should not merely become an exercise in saving money. However, unless policymakers are willing to make major changes, Medicaid will threaten to crowd out spending for other services citizens have come to expect from government, force substantial tax increases, or both.

This brief described the existing Medicaid system, its cost pressures, and experiments aimed at reducing cost growth. Subsequent briefs will look at the role of private long-term care insurance, describe how other developed nations provide such care, and explore ideas for fundamental change in the way long-term care is financed and delivered in the United States. The fundamental question that reformers must answer is whether this care should be provided as part of the nation’s structure of social insurance, whether it should be an individual responsibility, or some combination of the two.

Resources, we’ve got resources

So much information, so little time! Here’s a list of resources that have come across our desks recently. Most are new; one isn’t, but the issue of paying caregivers is before us always, and especially as government budgets are being tweaked.

Aging workforce
“The National Association of Professional Employer Organizations wanted to know what the small businesses its members serve are doing about their aging work forces.” Don’t be put off by the authorship: Older and Wiser: As the Work Force Ages, Small Businesses Change, Too is a fascinating and useful report.


Alzheimer’s disease
Alzheimer’s Association report on prevalence, March 2007.
“There are now more than 5 million people in the United States living with Alzheimer’s disease. This number includes 4.9 million people over the age of 65 and between 200,000 and 500,000 people under age 65 with early onset Alzheimer’s disease and other dementias. This is a 10 percent increase from the previous prevalence nationwide estimate of 4.5 million.”

According to Senator Barbara Mikulski (D-MD), “Now we need an All-American effort to not only find breakthroughs, but to make sure we are giving patients and their families the support they need.”

Medicare and Medicaid primers
New Medicare primer
New Medicaid primer

“Together, Medicare and Medicaid provide health coverage to about 90 million Americans. To help explain the two programs, the Kaiser Family Foundation has issued a new primer on the Medicare program and an updated version of its primer on the Medicaid program. Prepared by Foundation staff, the primers provide an overview of the programs, who they serve, how the programs work, and how they are financed.”

Paying for quality care
Paying For Quality Care: State and Local Strategies for Improving Wages and Benefits for Personal Care Assistants “was written by Dorie Seavey and Vera Salter in October 2006 and published by the AARP Public Policy Institute. This report examines state and local initiatives to improve wages and benefits for direct-care workers delivering Medicaid personal care services. The authors outline seven strategies -- wage pass-through legislation, rate enhancements linked to provider performance goals, updated reimbursement rates, litigation against state Medicaid agencies, collective bargaining, living wage ordinances and minimum wage improvements, and health insurance initiatives -- discussing the advantages and disadvantages of each.”