Medicaid Medicare Your Coverage Options

New and innovative home and community-based services for older adults

Written by Diane Archer

According to a new report from the Commonwealth Fund, 12 million older adults with Medicare have mild or serious physical or cognitive impairments (PCI) but millions cannot afford home and community supports and often end up in nursing homes. More than one in three of them have incomes below twice the federal poverty level but do not qualify for Medicaid. Fortunately, there are several new and innovative home and community-based services administered by the Centers for Medicare and Medicaid Services (CMS) to help older adults remain in their homes and communities, and the report proposes some new ones.

CMS programs that provide home and community-based care include Independence at Home, Hospital at Home, PACE–which you can read about on Just Care hereCommunity Aging in Place, Advancing Better Living for Elderly (CAPABLE)–which you can read more about on Just Care here–and Maximizing Independence for Persons with Dementia (MIND) at home. While all these programs are relatively small and may not be available in your community, if you are looking for home and community-based care for yourself or someone you love, it’s worth seeing whether these programs can help.

Older adults with serious physical or cognitive impairments, such as dementia, have a high likelihood of having multiple chronic conditions. Nearly two thirds of those living in the community have three or more chronic conditions. Virtually all of them have at least one chronic condition.

Programs that offer community and home-based supports can improve the quality of life of older adults with PCI, helping them maintain their independence and keeping them out of nursing homes. So, the Commonwealth Fund is proposing two additional cost-effective options for providing home and community-based services for older adults who do not qualify for Medicaid.  These programs are designed to delay nursing home admissions, so they could save CMS substantial money.

  1. Medicare Help at Home would offer supplemental home and community-based care. People with Medicare could elect this benefit on turning 65. Older adults with PCI would be able to receive 20 hours a week of personal care services at home or the cash equivalent, $400 a week, for other care services. Older adults would contribute anywhere from 5 to 50 percent of the cost based on their income. A combination of income-related premiums, an extra monthly premium of $42 and a small payroll contribution from employees and employers of 0.4 percent would cover the cost. And, it could save Medicaid $1.6 billion over 14 years.
  2. Medicaid Community First Choice, a program that provides supports for people with incomes up to 150 percent of the federal poverty level available in nine states, could be made available to all people with Medicare with incomes up to 200 percent of the federal poverty level who are eligible for nursing home care. It would cost $16,224 per person a year. But, costs would be offset by fewer nursing home placements, which cost $80,000 per person a year.


Here’s more from Just Care:


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