As seniors encounter a health care system that increasingly emphasizes home and community medical care over residential long-term care, they are being provided with opportunities to receive important medical services at home.
Changes to Medicaid have helped contribute to this focus on keeping seniors in their home and community for as long as possible. In fact, in 2013, Medicaid spent more on its long-term supports and services program than it did on nursing home care.
Why Is Managed Care Necessary?
Although government programs are increasingly working toward pulling seniors out of a nursing home setting and encouraging community-based services, some seniors still require the long-term care that they can only receive in a residential facility.
The problem lies in the fact that many of these seniors do not have Medicare, and Medicaid does not always provide the benefits and services that vulnerable, low-income seniors require, a conundrum that often leaves such seniors dependent on family to step in or look to other options such as managed care.
How It Works
Managed care systems have been in place for younger adults for years. In it, clients choose a group of physicians in a managed care organization (MCO) to provide their services for a set cost. This cost is agreed upon between physicians and insurance companies.
The idea is a win-win for all parties involved. With a Medicaid managed long-term care group, the state works with insurance companies, paying the MCO a fixed fee each month for each senior enrolled. Seniors receive the service they need while physicians receive a fair payment for their services. In addition, since physicians and laboratories will not have the ability to raise their prices just for profit’s sake, corrupt or unscrupulous physicians will be pushed out of the medical community altogether.
Should MC Be A Requirement For Seniors?
The reputation of nursing homes as places to “go to die” and under the belief that Medicaid spending in nursing homes is hyperinflated, has led to many states placing low-income seniors in managed care along with women and children who receive Medicaid.
The statistics seem to support at least one of the claims. According to some statistics, seniors and the disabled account for only 6% of those enrolled in Medicaid, but represent almost 50% of the government program’s spending. This has led to at least fifteen states mandating seniors to transition to a managed care system to curb costs and encourage home and community health services.
MC In Pennsylvania
Pennsylvania is one of the most recent states to consider managed care options for seniors who currently reside in nursing homes. The state plans to consolidate two separate programs into one that will emphasize choice and independence, with the ultimate goal of allowing seniors to stay in their homes longer.
The managed care program is being touted not as a money-saving effort but one that is intended to increase the quality of care among seniors in the state. It is slated to start in Pittsburgh and the surrounding area on January 1, 2018, and then expand to include the rest of the state by January 1, 2019.
What MC Means For Your Loved One
It is impossible to predict how the managed care program will play out in Pennsylvania, but there are reasons to believe that senior care will only improve with its implementation. First, a managed care program is more likely to allow specialized services, particularly those that focus on home care or those services that help seniors stay in their home or community.
It is likely physicians will feel more comfortable ordering costly procedures that individually they may not want to chance. Second, managed care focuses on keeping patients healthy instead of treating them after they have become sick. This will ensure that your loved ones receive preventative services that could add years to their lives.