JustCare

Tag: Medicaid

  • Trump reelected: What happens to health care?

    Trump reelected: What happens to health care?

    With Donald Trump on his way back to the White House, we can be sure that our health care system will change dramatically over the next four years. Sarah Owermohle reports for StatNews on ways in which Trump could restructure US health care.

    As Trump said in his victory speech, Robert F. Kennedy Jr. is likely to be in charge of “mak[ing] America health again.” It’s not at all clear what that means. Americans appeared less focused on health care this election and more focused on the economy. However, health care costs are part of the economy and have always been a large concern for Americans.

    This go round, Trump claims he won’t try to end the Affordable Care Act. He says he simply wants to reduce costs. That could mean lower costs for healthy people and higher costs for people who need care. It could also mean health insurance options that are not comprehensive, for example, insurance that does not cover prescription drugs.

    Tax credits that help people with low incomes afford insurance premiums could not be extended at the close of 2025, when they expire. Republicans in Congress don’t support them.

    Trump says he will not support a law that bans abortion in American. He intends to prevent funding for gender-affirming care and prohibit it for minors entirely. He will protect employers’ right to refuse to cover birth control based on their religion.

    What will Trump do with Medicare? During his last presidency he ultimately decided not to support lower drug prices. Will he try to undo Medicare drug price negotiation for high-cost drugs?

    Both Medicare and Medicaid are on the table. He might try to do away with traditional Medicare. Although Medicare Advantage has cost the Medicare program significantly more than traditional Medicare, Republicans in Congress still look to the corporate insurers offering Medicare Advantage plans to contain costs. Trump left open the possibility that he would cut spending on Medicare and Medicaid. In his first presidency, he gave states permission to put work requirements on some people with Medicaid.

    Trump says he wants a commission to look at the growth of chronic illnesses in America. Who knows what that will lead to. To date, he has not embraced RFK Jr.’s notion that vaccines are responsible for chronic diseases. RFK Jr. will not lead the Department of Health and Human Services, according to a Trump spokesperson, but he still could have significant authority over recommended vaccines.

    On a brighter note, Trump has said he will ensure access and insurance coverage of in vitro fertilization.

    Trump says he supports tax credits to help with the costs of  America’s 53 million plus caregivers. He has yet to offer details as to what that would look like. Health savings accounts, which tend to be of little help to people when they need costly care, is one way he might go.

    Here’s more from Just Care:

  • Getting public assistance? Beware of Medicare Advantage flex cards

    Getting public assistance? Beware of Medicare Advantage flex cards

    Maya Goldman reports for Axios on the risks of Medicare Advantage flex cards for people getting public assistance. The extra money people think they’re getting through a flex card could mean the end of your government housing or food benefits. UnitedHealth, Humana, CVS offer these cards to entice people to join their MA plans without warning people that the cards could mean the end of their public assistance, even if they don’t use them.

    How is it possible people can lose precious benefits? Government agencies can count flex cards as income. So, when people apply for Supplemental Security Income or rental assistance, adding the value of the flex cards to their income could disqualify them.

    Why are Medicare Advantage plans offering flex cards when they could be harmful to enrollees? It’s hard to imagine insurers are concerned with the risks of giving flex cards to disabled and low-income enrollees. They likely see the flex cards simply as a good hook to boost enrollment and profits.

    Some of the flex cards are specifically targeted to use on items such as groceries and electric bills. Each Medicare Advantage plan offers something different. But, the value of these cards can be significant, with an average value of nearly $1,000.

    People with Medicare and Medicaid could be far better off in traditional Medicare, with coverage from most providers in the US and without the prior authorization obstacles to care people face in Medicare Advantage. But, an extra several hundred dollars a year from a Medicare Advantage plan to offset grocery or utility costs is hard to pass up.

    Ideally, the Biden administration could direct agencies not to consider the flex cards as income, as more than 30 Democratic members of Congress have requested. But, regulations and statutory mandates for different agencies could get in the way of that. Alternatively, CMS should permit insurers to use the money in the flex cards for a different benefit, such as over-the-counter drugs, which would not be considered income.

    The Department of Housing and Urban Development (HUD) excludes most Medicare Advantage benefits from a person’s income when they apply for help. But, HUD is required by statute to count certain utility and rent benefits as income.

    One other concern: People can be misled about the flex cards. They can come with a bunch of limitations that prevent people from using them as they expected. Of course, the insurers profit more if people don’t use their flex cards.

    The insurers, for their part, have done nothing to address the serious issues their flex cards present for some of their most vulnerable enrollees.

    Here’s more from Just Care:

  • Donald Trump’s threat to Medicare and Social Security

    Donald Trump’s threat to Medicare and Social Security

    Donald Trump was the worst president for seniors in the history of the nation. That is not hyperbole. Alarmingly, if elected again, he will be even worse—and, worryingly, more effective.

    When Trump ran for president in 2016, he claimed he would be the one Republican not to cut our earned benefits but, when he actually became president, every single one of his budgets proposed deep cuts to Social Security and Medicare, as well as Medicaid.

    When Trump couldn’t get the cuts enacted, he employed the old tactic of “starve the beast.” Figuring tax cuts are easier to enact than benefit cuts, he cut income taxes which help to fund Medicare and Medicaid, and sought to defund Social Security, which has its own dedicated revenue source.

    To advance his goal of undermining Social Security, Donald Trump grabbed the questionable power to go after its dedicated revenue unilaterally—something without precedent. Because Trump was limited to executive action, he was able to only defer the revenue, but he made clear that he would not just defer the revenue, but eliminate it, if he were re-elected. Insufficient dedicated revenue leads to automatic cuts. Conveniently, automatic cuts means there is no one to clearly be held accountable.

    Trump’s goals to undermine these programs, so vital to seniors, have not changed. Trump continues to claim he won’t cut benefits despite his record to the contrary, but tells the truth from time to time. Moreover, he is reportedly considering, once again, defunding Social Security, if he has the chance. Trump also plans to continue to give his billionaire friends massive tax giveaways.

    And we know what those cuts will look like. The Republican Study Committee, which includes 80 percent of all House Republicans and 100 percent of House Republican leadership, releases a budget every year. Every year, it contains deep, draconian cuts and radical transformative proposals for Social Security. Indeed, its recently-released FY 2025 budget slashes Social Security’s already inadequate benefits by $1.5 trillion in just the first ten years. In fact, it cuts Social Security by $73 billion in the first year alone.

    These are much deeper cuts than are necessary to eliminate Social Security’s modest projected shortfall. And they would occur much sooner than if Congress did nothing whatsoever! Even worse, the Republican proposal would radically transform Social Security, ending it as we know it.

    Social Security provides wage-related benefits designed to maintain one’s standard of living when wages are lost in the event of old age, disability, or death. Today’s extreme Republicans want to instead provide only subsistence-level benefits, designed to barely keep beneficiaries above abject poverty. And these radicals propose to privatize Social Security and Medicare, on top of that.

    For years, politicians have talked about giving Medicare the power to negotiate lower prescription drug prices. Biden got it done. Thanks to Biden, out-of-pocket insulin costs have been capped at $35 per month, hearing aids are cheaper, and inhaler prices are lower. If Trump wins a second term, he has made clear he will seek to repeal those reforms, just as he sought to repeal the Affordable Care Act. Nor will Medicaid be spared.

    None of this should be a surprise. Before running for president, Trump slandered Social Security by calling it a Ponzi scheme – an illegal enterprise used to dupe and defraud the unsuspecting. He supported privatizing Social Security and raising the retirement age, with the condescending remark, “how many times will you really want to take that trailer to the Grand Canyon?”

    Before running, Trump praised proposals by former Republican vice presidential nominee Paul Ryan that would have destroyed Medicare by turning it into a voucher program, forcing seniors to fend for themselves in a hostile market.

    And there’s more evidence of Donald Trump’s true plans. Look who Trump surrounded – and continues to surround – himself with. Everyone around Trump is hostile to these programs.

    In 2016, Donald Trump picked Mike Pence to be his running mate, despite the fact that Pence had a clear record of favoring cuts to these programs, including raising the retirement age and privatizing our earned benefits. Pence wouldn’t help Trump steal the 2020 election so he is being replaced – but not because of his policy views on Social Security, Medicare, and Medicaid. Those who are reportedly being considered have as hostile or even worse views than Pence.

    And Trump’s other appointments were no better. Just to name two, Trump appointed extreme Social Security, Medicare, and Medicaid opponent Mick Mulvaney as his Director of the Office of Management and Budget, and later chief of staff. Mark Meadows, another Trump chief of staff (currently under indictment) also has a long record of supporting massive cuts to Social Security, Medicare, and Medicaid.

    Perhaps even more concerning than Trump’s hostility to programs that are vital to seniors is his utter disregard for their health and well-being. It was seniors who overwhelmingly bore the brunt of Trump’s completely incompetent handling of the COVID pandemic. Too many Americans, disproportionately seniors, died because of Trump.

    Rather than deal effectively with the pandemic, Trump’s administration shockingly used it to further Trump’s goal of undermining Social Security. At the height of the pandemic, Trump’s son-in-law Jared Kushner proposed pressuring desperate Americans, thrown out of work because of the impact and dangers of COVID, to trade their earned Social Security benefits for upfront, immediate cash. Fortunately, it went nowhere, but did show a single-minded effort to rip away the protections of Social Security despite where the focus should have been – on saving lives.

    It is essential that the American people not be fooled by the rhetoric. Trump has shown he understands how unpopular cutting Social Security, cutting Medicare, cutting Medicaid, and raising drug prices are with everyone but his billionaire donors. But he showed early on that he understood the politics. In 2011, for example, Trump told Sean Hannity that Republicans “are going to lose elections” if they “fall into the Democratic trap” of advocating cutting Social Security, Medicare and Medicaid without bipartisan cover.

    So don’t be fooled. Social Security, Medicare, Medicaid, and drug prices are on November’s ballot. Donald Trump will be more effective this time around. The choice is clear: Trump and his Republican allies in Congress want to cut Social Security, cut Medicare, cut Medicaid, and increase the already-huge profits of drug companies while giving tax breaks to Big Pharma and their other billionaire friends. Democrats want to expand Social Security, expand Medicare, lower drug prices, and force billionaires and multinational corporations to pay their fair share.

    For the sake of all of our economic security, it is essential that the American people, and seniors in particular, understand this fundamental difference between the two parties and vote accordingly.

    [This post was originally published on Common Dreams.]

    Here’s more from Just Care:

  • States address prior authorization denials, while Congress fears to tread

    States address prior authorization denials, while Congress fears to tread

    People across the country are facing increasing numbers of treatment denials from insurers, even after their insurers have approved these treatments for extended periods. Shalina Chatlani reports for Medical Express on how some states are addressing these prior authorization denials that are undermining patients’ continuity of care and causing them serious hardship. Meanwhile, Congress has been unwilling to act in meaningful ways.

    One patient suffering from chronic pain had been getting monthly infusions for pain relief. Then, Medicaid refused to cover these infusions. After many months, the corporate insurer administering Medicaid benefits decided to overrule the patient’s treating physician and deem the treatment medically unnecessary.

    Prior authorization denials keep health care spending down. They also enrich the insurers that contract to deliver Medicare and Medicaid services as well as coverage for working people. They are generally paid a fix rate upfront. What they don’t spend, they are largely able to keep for themselves, so they have an incentive to deny care or delay care. It helps to maximize their profits.

    Insurers leave patients without needed treatments, often to the detriment of their health and sometimes their lives. States have been stepping in to reduce the number of prior authorization delays and denials. Nine states have laws in place now to protect patients.

    New Jersey addresses insurer delays of care by requiring insurers to make determinations as to whether care is covered within 72 hours of a request. In Texas, doctors whose requests to provide care are approved 90 percent of the time receive a “gold card” that eliminates their need to seek prior authorization. But, to date, only three percent of doctors in Texas have gold cards.

    Washington has a law that ensures insurers make swift prior authorization determinations. Michigan ensures that insurers use only prior authorization processes that are peer-reviewed and approved. Arizona is considering a law that would require insurers to honor their own, or another insurer’s prior authorization determination if someone switched insurers, within 90 days of the determination. But, it would not apply to Medicaid patients.

    What’s insane is that our federal government effectively trusts insurers to implement prior authorization rules that are evidence-based and appropriate, with little oversight to ensure that is the case, even though mountains of evidence indicate that it is not. Moreover, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare and Medicaid, has little ability to hold insurers accountable when they violate prior authorization regulations.

    A new CMS rule is intended to speed up insurer prior authorization decisions for medical services. It goes into effect in 2026. But, it has no meaningful enforcement mechanism. As well, inexplicably, it does not apply to insurer determinations as to whether a drug is covered.

    State laws, for the most part, only apply to private health insurance that is state-regulated. Consequently, people in ERISA plans, who work for companies that self-fund their health insurance, are not protected by state laws. These laws also generally do not protect people with Medicaid.

    One recent study found that one in five people with cancer are denied care their treating physicians recommend. The American Medical Association found that patients often experience “serious adverse event(s)” as a result of prior authorization processes.

    Even when states are able to detect violations by insurers and hold them accountable, the penalties generally are so small as not to be a deterrent for the large insurers. One expert suggested holding insurance company medical directors accountable for wrongful prior authorization determinations; medical directors could be sued for malpractice. Oklahoma is considering a law that would do that.

    Here’s more from Just Care:

  • Half of rural hospitals are losing money, closing units

    Half of rural hospitals are losing money, closing units

    Jazmin Orozco Rodriguez reports for Kaiser Health News on the failing finances of half of rural hospitals. They are losing money. A big part of the reason are the insurers offering Medicare Advantage plans who don’t pay these hospitals the money they are due.

    “The rapid growth of rural enrollment in Medicare Advantage plans, which do not reimburse hospitals at the same rate as traditional Medicare, has had a particularly profound effect.” Insurers don’t profit as much from rural enrollees, so they do not pay rural hospitals adequately, which our government unforgivably allows them to do. (Most people don’t appreciate that government payments to Medicare Advantage plans are based on the payment rates in traditional Medicare.)

    What’s happening? In many cases, rural hospitals are closing their operating rooms and obstetrics units. Hundreds of hospitals have stopped providing chemotherapy. Expenses are greater than revenue. Hospitals cannot find enough workers. And, administrative challenges are large.

    Where are the hospital closures happening? All over the US, particularly in small communities. Chartis describes that, in the last year alone, one in two rural hospitals operated in the red. That’s nearly a ten percent increase from the year before.

    How many hospitals are at risk? Chartis found that 418 rural hospitals were at risk of closing. Of note, those rural hospitals in states with expanded Medicaid coverage were in better shape financially than those in states that did not opt to expand Medicaid.

    Medicaid expansion to low-income adults has helped ensure access to care health care in those states a lot: In Montana, for example, as a result of Medicaid expansion, there are half as many uninsured residents as there had been. Access to care for Montanans has improved. And, rural facilities are still operating. No hospitals have closed in the last nine years.

    The future looks grim for rural hospitals and the people who live in their communities, according to Chartis. Even non-profit hospitals can’t survive financially in rural America. The hospitals have no profit margin. Rural residents tend to live on low incomes, to be older and in poorer health. Overall, they have shorter life expectancies than Americans living in other areas.

    Alan Morgan, CEO of the National Rural Health Association notes that Congress needs to do more: “It’s just bad public policy. And bad policy for the local communities.”

    Here’s more from Just Care:

  • 2024: Programs that lower your health care costs if you have Medicare

    2024: Programs that lower your health care costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs, leaving people with average annual out-of-pocket costs of $7,000. So, even with Medicare, many people struggle to afford premiums, deductibles and other costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Click here or contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible for any of these programs and how to apply.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2024, but vary somewhat by state. You might still qualify for these programs in your state even if your income or assets are higher than the federal amounts listed below. States sometimes exclude certain income and assets when determining your eligibility. You should apply through your state Medicaid office.

    • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan. It should cover premiums, deductibles, coinsurance and copays for Medicare-covered services.
      • Income limit monthly depends upon where you live but is around
        • $1,275 for individuals
        • $1,724 for couples
      • Asset limit
        • Individuals: $9,430
        • Couples: $14,130
    • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20. SLMB helps pay your Medicare Part B premium, if you have Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,526 for individuals
        • $2.064 for couples
      • Asset limit
        • Individuals: $9,430
        • Couples: $14,130
    • Qualifying Individual (QI)—135 percent of FPL +$20, helps pay your Medicare Part B premium if you have Medicare Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,715 for individuals
        • $2,320 for couples
      • Asset limit
        • Individuals: $9,430
        • Couples: $14,600

    Several valuable items are not counted as income and assets. No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You will automatically qualify for the Extra Help program, which is administered by Medicaid, if you qualify for Medicaid or any of the above low-income programs or receive Supplemental Security Income benefits. You can also apply for Extra Help independently. Extra Help pays for some or all of the cost of your Part D drug coverage and is estimated to be worth around $5,100 a year. The amount of help with cost-sharing depends on the level of your income and assets. In 2024, you may qualify if you have up to $22,590 in annual income ($30,660 for a married couple) and up to $17,220 in assets ($34,360 for a married couple). With Extra Help your drug costs are no more than $4.50 for each generic/$11.20 for each brand-name covered drug. If your total drugs costs–what you and your health plan pay) go above $8,000 this year, you’ll pay nothing more. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)

    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-fee scale. They might waive the Medicare deductible and coinsurance, depending upon your income.

    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • Corporate health insurers generate sizeable profits covering people with Medicare and Medicaid. Why?

    Corporate health insurers generate sizeable profits covering people with Medicare and Medicaid. Why?

    Corporate health insurers are generating sizeable profits covering care for people with Medicare and Medicaid, sometimes called “dual-eligibles,” reports Caitlin Owens for Axios. The question is why these for-profit insurers are able to earn billions in profits from the dual-eligible population who generally need a lot of health care? Are the insurers withholding needed care inappropriately in order to pocket the money they don’t spend and maximize profits?

    What’s noteworthy is that the largest corporate health insurers have moved big time into the Medicare and Medicaid health care markets. They clearly see big dollar signs in the Medicare and Medicaid markets. In fact, their profits for people with Medicare are projected to be two-thirds more than their profits for working people.

    Of the 65 million Americans with Medicare about 13 million have both Medicare and Medicaid. Nearly four million of them are enrolled in corporate health plans that are supposed to cater to their special needs, called Medicare Advantage Special Needs Plans. All told, around seven million of them are enrolled in either a special needs Medicare Advantage plan or simply a Medicare Advantage plan that covers a broader array of people.

    More than 11 million dual-eligible individuals have incomes under $20,000 a year. More than five million of them have long-term disabilities and are under 65. More than three milion of them have at least five chronic conditions.

    McKinsey recently issued a report estimating that corporate insurers will see their profits grow treating dual-eligibles, increasing more than 70 percent to $12 million over the five year period ending in 2027. Why? The government pays more to treat dual-eligibles because they have costlier health care needs. But, insurers are clearly not spending proportionally more on this population.

    Profit margins are particularly high for insurers covering dual-eligibles, according to MedPAC, and that’s especially true if the insurers attract dual-eligible enrollees who don’t receive a lot of care.

    Here’s more from Just Care:

  • CMS should not be hiding Medicare and Medicaid data

    CMS should not be hiding Medicare and Medicaid data

    Researchers are up in arms against a plan to restrict access to Medicare and Medicaid data by the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare and Medicaid. The CMS plan will make it harder for researchers to access and analyze Medicare and Medicaid data as they please. This data is critical for understanding what’s working and not working in our health care system for different populations and in different geographic areas, explains Ge Bai, a professor of accounting and health policy at Johns Hopkins in Forbes.

    Medicare and Medicaid data reflects health care usage by 4o percent of insured Americans, allowing researchers to report on how well our health care system is working for different populations. But, CMS just announced that it’s ending the ability of institutions to use Medicare and Medicaid data freely, easily and inexpensively. Rather, it will charge more for this data and impose many more restrictions on its use. CMS plans to begin this new policy in 10 weeks.

    As it is, CMS is not collecting key Medicare Advantage data that would help researchers better understand the care people are receiving in their Medicare Advantage plans.

    Bai outlines three serious implications of this new CMS plan.

    1. It will be harder for researchers to study Medicare and Medicaid, so less research will occur. This will limit government accountability and shield CMS from public scrutiny. We need external oversight to ensure CMS ensures Medicare and Medicaid are working as well as possible. External analysis of data will always add a new array of insights and solutions for improving Medicare and Medicaid and the health of older adults and people with disabilities and low incomes.
    2. It will end a lot of research by independent entities. Already today it is too expensive for smaller entities to access CMS data. The administration will control the narrative about the data.
    3. Cronies will benefit from requiring the purchase of data at a high price from CMS.

    CMS claims that it is concerned about data breaches but has not indicated that researchers’ use of the data has led to breaches. Moreover, CMS could easily do more to minimize the likelihood of breaches without restricting access to data and harming the public good.

    CMS is undermining data transparency in its own agency at the same time that it is requiring more transparency from hospitals and other health care stakeholders. How does this promote competition?

    CMS claims to own the Medicare and Medicaid data, but in truth the public owns it. CMS is charged with collecting data. But, the public cannot assess CMS’ work without access to the data. Of course, it can be deidentified.

    For the good of Medicare and Medicaid and the people who benefit from it, CMS should make all its data easily available to researchers at a fair price.

    Here’s more from Just Care:

  • Mental health treatment remains challenging to come by, even with insurance

    Mental health treatment remains challenging to come by, even with insurance

    Notwithstanding federal law requiring “mental health parity”–insurance coverage for mental conditions–mental health treatment remains hard to come by in the US. Even with health insurance, the majority of Americans in need of treatment for a mental health condition could not get it in 2021. If you have Medicare, few health care providers are willing to treat you because Medicare’s rates are so low, and the data suggest that Medicare Advantage plans do a poor job of including mental health providers in their networks.

    About one in five people in the US have a mental health condition. But, only a small minority of them are able to get treatment for their conditions. Fewer than one in seven people with Medicare–15 percent–receive treatment for mental health conditions.

    A story on NPR, based on a new Milliman report, explains that about two in three Americans with health insurance could not receive treatment for their mental health conditions. Of the people experiencing mental health crises who required emergency treatment or hospitalization, only one in three got follow-up treatment within 30 days of leaving the hospital.

    Inseparable, an advocacy group focussed on the treatment of mental health conditions, commissioned the Milliman report. Its founder, Bill Smith, wanted to see the data underlying the endless stories his group was hearing about insurance companies refusing to cover mental health care.

    What keeps people from getting treatment for mental health conditions? In addition to a health insurance industry that does not want to cover the care, there’s a shortage of workers, poor provider reimbursement rates, and government failure to ensure compliance by insurance companies to cover mental health care as required under federal law.

    Milliman’s findings show that almost one in four people with insurance, including Medicaid, Medicare and commercial insurance, had a minimum of one mental health condition in 2021. People with Medicaid had the highest likelihood of receiving mental health care.

    Here’s more from Just Care:

  • The challenges of caring for aging parents in the US

    The challenges of caring for aging parents in the US

    An article in The New York Times by Reed Abelson and Jordan Rau captures the plight of family members caring for aging parents in the US. The journalists profile several individuals who are managing care for parents and grandparents, with cancer, dementia and other complex conditions. One woman sums up the situation with these words: “The health care system for the elderly is neglected, broken and inadequate to meet any demands, even the basic needs.”

    To be clear, if you are not eligible for Medicaid, your long-term care costs could be exorbitant. Medicare does not cover long-term care. For many people, long-term care costs are unaffordable. Even with Medicaid, it can be hard to get long-term care.

    Medicaid should be picking up the costs of long-term care for people with low incomes. But, eligibility requirements are restrictive, and even when people meet them, there can be long waits to get needed care. There are not enough health aides, so agencies will hire anyone who is willing to take on this role. When aides don’t show up, replacement aides are hard to come by.

    To keep costs down, often children of aging parents bring their parents in to live with them. And, while that makes it easier to ensure they are getting needed care, it can keep them from working outside the home. In some cases, older adults cannot be left alone. To make ends meet, adult children are forced to institutionalize their parents so they can work outside the home.

    Single adults, living alone and needing to care for aging parents, are in a particularly difficult bind. They lack a partner to share the work of caring for aging parents, while earning an income to sustain themselves. Unless they are wealthy, they have few options when their aging parents develop dementia or otherwise need ongoing help with activities of daily living and are in need of fulltime care.

    A 60-year old actor from Topeka, Kansas explains that it cost $8,000 a month to provide just eight hours a day of care for her mom. That cost is not sustainable for the vast majority of Americans with limited savings. Then, her mom fell, broke her sacrum, got 100 days of Medicare rehab and was once again left without a viable care plan. Her daughter and her siblings cashed out her life insurance policies to pay $65,000 for a year of nursing home care. Medicaid eventually picked up some of those costs after her mom spent down more of her assets. Now, her mom has died and the state is asking for almost $20,000 back.

    A California professor and his wife had a plan for his mom, one that would not destroy his own retirement savings. But, his mom lost some cognition after a stroke. The least expensive way to care for her was at an assisted living facility, costing $4,500 a month. His mom only gets $1,500 a month from Social Security and has no other funds to cover these costs. He negotiated with the assisted living facility and launched a GoFundMe campaign. But, in his 60’s, he’s figuring out what new work he can do to pay the balance of his mom’s monthly bills.

    A 60-year old retiree from Greenville, South Carolina explained that her mom, was getting terrible care in an independent living facility. No one was engaging with her. Before long, her mother got sick and needed a wheelchair to get around in her assisted living facility. The assisted living facility cost $8,000 each month and was quickly depleting her $120,000 in savings. She had no additional financial support beyond $2,500 a month in retirement income. Her daughter and son-in-law were unable to get away until she died.

    A 55-year old college professor from Vermont found a new home for her family so that she could move her mom in to live with them. Her mom had been in California, where she could not drive any longer or otherwise adequately care for herself. Her mom had dementia. Adult care was extremely costly. Moreover, her mom became violent. No nursing home would take her. She was sent back to live with her family, who had to give her drugs to calm her. She died soon after.

    Here’s more from Just Care: