Improving Benefits and Integrating Care for Older Medicare Beneficiaries with Physical or Cognitive Impairment.
Issue: Two-thirds of Medicare beneficiaries with physical and/or cognitive impairment (PCI) who live in the community have three or more chronic conditions and could benefit from integrated medical and social services. Over one-third of those with PCI have incomes under 200 percent of the federal poverty level but are not covered by Medicaid, exposing them to risk of financial burdens and nursing home placement. Goal: To analyze two policy options that expand financing for home- and community-based care for older adults with PCI. Methods: Potential costs are estimated using the Medicare Current Beneficiary Survey. Key findings and conclusions: Medicare Help at Home—a proposal to add supplemental home- and community-based services—could
be financed by income-related cost-sharing, beneficiary monthly premiums of $42, and an incremental payroll tax on employers and employees of 0.4 percent. This could produce savings to Medicaid of $1.6 billion over 14 years. Using a different option—an extension of Medicaid Community First Choice—would cost $16,224 per person assisted, with costs offset by reduced nursing home placement.
Department of Health Policy and Management and Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, USA. awillin2@jhu.edu
Amber
A
Willink
Department of Health Policy and Management and Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, USA.
Karen
Davis
Commonwealth Fund
Cathy
C
Schoen
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000628:therapy; D003153:Community Health Services / Q000191:economics; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000706:statistics & numerical data; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007342:Insurance Benefits; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D011203:Poverty; D014481:United States