Advocacy News
The NEWS page has been moved to News Archive - covering from July 2010 - November 2011.
Dual Eligibles
The MA Department of Health and Human Services maintains a webpage with extensive information on Dual Eligibles: Integrating Medicare and Medicaid for Dual Eligible Individuals.Recent Events
- MA Department of Health and Human Services held public hearings on the December 7 document on January 4 in Boston, and December 16 in Worcester. Over 400 attendees testified. While the theories are good, most advocates have concerns.
- How important are long-term services and supports for you such as PCAs, peer support, and durable medical equipment? What would happen to you if they were reduced? Based on your current experience, what are your concerns about possible reductions?
- How important is the right to choose services and doctors? Do you change doctors and services now? Based on your current experience why is it important for you to choose your services and doctors?
- Do you think it is okay if health insurers or hospitals or physician groups run community services? Based on your current experience what are your concerns about health insurers or hospitals or physicians running community services? Have physicians ever ignored your needs in ordering services?
- Would you want someone from an independent living center or a recovery learning center or an ASAP to help coordinate your community services? Who should plan your care? Based on your current experience what concerns would you have about doctors, nurses and other medical providers coordinating your community services? Do you want to decide who is on your care team?
- For this new plan, would you be concerned about being automatically enrolled? Based on your current experience in the health care system, what are your concerns about automatic enrollment?
- In response to federal initiatives to streamline and improve service delivery for dual eligibles, MA released "STATE DEMONSTRATION TO INTEGRATE CARE FOR DUAL ELIGIBLE INDIVIDUALS" on December 7, 2011. Under the Demonstration guidelines and based on a person-centered medical home (PCMH) model, MassHealth and CMS (Centers for Medicare & Medicaid Services) will use combined Medicaid and Medicare funding to contract with Integrated Care Organizations (ICO), using a blended capitation financial arrangement, to provide integrated, comprehensive care for dual eligible adults under age 65.
Background
Who Are Dual Eligibles? Dual Eligibles are individuals, aged 21-64, who receive coverage under the Medicare and Medicaid programs because they meet Medicaid financial eligibility rules and also have significant disability due to chronic illness, physical disability, behavioral health problems, or developmental disability.
Under the Medicaid and Medicare programs, duals receive access to a comprehensive set of services. Medicare is the primary payer for acute services, such as hospital and physician services. Medicaid pays for long-term support services (LTSS) provided to duals living in the community and in long-term nursing facilities. Medicaid also acts as the secondary payer for some Medicare-covered services when it helps beneficiaries with payment of Medicare deductibles and copayments.
2011 Study used data on approximately 105,000 enrollees in 2008: dual-eligibles-in-ma.pdf- Providers paid on a fee-for-service basis
- Average per person combined spending was $23,700 with wide variations
- Majority of individuals live in the community
- Per capita spending for duals receiving a high level of support services while living in the community was $56,200, while duals in institutions averaged $101,900 per year.
Transportation
- NEWS FLASH, January 19, 2012, Transportation 2012-01-19-newsflash-transportation.pdf
The ABLE Act
Achieving a Better Life Experience - The ABLE Act was reintroduced to Congress in November 2011 by Rep. Ander Crenshaw (R-FL) in the U.S. House of Representatives and Sen. Robert Casey (D-PA) in the U.S. Senate. The Act has bi-partisan support.
The National Disability Institute 
has more information on how you can support this bill.
The Act allows individuals with disabilities and their families to set funds aside in a tax-advantaged savings account that allows the funds to be withdrawn to cover costs of health care, housing, transportation, the purchase of technology and lifelong education. The funds will supplement but not replace benefits provided through Medicaid, Social Security and private insurance, allowing families with sons or daughters with significant disabilities a means to provide for extra costs associated with every day activities and community participation. The income earned on amounts contributed to an ABLE Account would be tax exempt and not counted as part of any asset limits for eligibility to federal programs. Download the summary: able-act-112-congress.pdf
