October 8, 2014
It is particularly difficult to provide appropriate health care and long-term care services to individuals who are qualified for both Medicare and Medicaid.
Such “dual eligibles” often require expensive care that is difficult to manage effectively.
Medicare-eligible persons are either age 65 or older, or have been determined disabled according to Social Security Disability criteria.
Medicaid-eligible persons have very limited financial resources, and often require long-term care services (that will be needed for an indefinite period).
In 2011, the State of Washington reported that services were being provided for about 115,000 dual eligibles, with about 65,000 age 65 or over and 50,000 under age 65 with disabilities.
Over the past few years, the State has focused substantial effort on trying to improve services and reduce the costs of care for these persons.
A proposal for a HealthPlanWashington program was submitted to the Department of Health and Human Services in 2012 by the Washington Health Care Authority and Department of Social and Health Services. After revisions were made, this proposal was accepted.
The Washington State Medicaid Plan (State Plan) has been revised to reflect this program.
The first step in implementation of the program was the development in 2013 of Health Homes (HH) to improve fee-for-service managed care.
Step 2 involves the delivery of services through a capitation model that involves both Medicare and Medicaid funding, in selected areas during 2014.
Dual eligible in King and Snohomish counties became eligible to voluntarily “opt-in” to this program starting October 1, 2014.
On January 1, 2015, auto-enrollment will begin, with voluntary “opt-out” available.
Elder Law attorneys will need to consider when the new HealthPlanWashington program will be in the interest of clients.
Access to program evaluation materials will be essential, in order to consider the advantages and disadvantages of client participation.
If services are improved for this population, a valuable new option will have become available.
If efforts to control costs prevail over access to services, clients will need to be cautioned about possible participation.
The dual eligibles represent a difficult-to-manage-and-care-for group. It will be important to assess whether or not interventions are improving client outcomes.
For this reason, attorneys may need to secure access to, and track, the evaluation efforts going forth.
More on Elder Law in Washington may be found in the “Elder Law” volumes of Washington Practice by Cheryl and Ferd Mitchell: Washington Elder Law and Practice (Vol. 26), the associated Elder Law Handbook (Vol. 26A), and the Washington Probate volume (Vol. 26B). These materials are available at www.legalsolutions.thomsonreuters.com under the tag Mitchell and Mitchell elder law. Additional updates may also be found on this blog under the tag Washington Elder Law Practice Reports.