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Historic Neighborhoods Worry Denver’s Sidewalk Crusade Could Cost Them Character

http://www.cpr.org/news/story/historic-neighborhoods-worry-denver-s-sidewalk-repair-crusade-could-cost-them-character

Why We Want MEDICAID for all Not MEDICARE for all –Part II

By Julie Reiskin

October 23, 2017

 

To remind readers, Part I of this blog post from early October began with my statement that I was recently in a discussion with someone about health care policy.  When I shared that CCDC does not support Medicare for All, and that we did not support Amendment 69 during the recent fall elections, there was shocked silence.  “Aren’t you the people always protesting and carrying on about health care?”   Yes-we are.

What follows are several more reasons not mentioned in Part I of this essay that compel CCDC to advocate for “Medicaid for All” as the way to go in health care reform ahead:

 

Medicaid has multiple requirements for public involvement. 

There is a federally mandated advisory council that requires client involvement.   In Colorado, just about every program has a robust public committee that complements other ways for the public to be actively involved.  If one was so inclined, one could go to meetings about Medicaid policy with the state every day of the week.  Nothing happens in Medicaid without an opportunity for public involvement.   This may sound tedious unless your life is altered by how rules are made or enforced.  This level of involvement is impossible on a national level.

As we all know, having lobbyists in DC opining on issues does not translate into understanding of how a policy affects the people.   We are slowly learning about some of the very negative effects of the recently passed 21st Century Cures Act which imposes national mandates on states to impose on Medicaid clients and providers.  The motivation may have been good, but the outcomes are bad.  Working things out on a state level in terms of day to day management of programs works much better than trying to write rules or policies on a federal level for every single issue.    Medicaid currently has national standards; those are clearly met.  The details are often left to the states.  If the states follow the rules, the states are not hassled.  If they fail to follow the rules, they have to answer for that.   Medicare, on the other hand, has no such accountability.   There is no workable process to solve a problem with Medicare in terms of how it works on a day to day issue.

 

There are other differences.

Medicare in some areas does pay better than Medicaid, but if there were more money in Medicaid, rates could be raised.  Over the past ten years, states have worked hard to get Medicaid rates at least close to the Medicare rate.  Most providers accept Medicare, not all take Medicaid—again, if the population on Medicaid increased and rates were increased a bit, that would change.   Some providers that do not take Medicaid have outdated information.  Many years ago, it was true that Medicaid would take forever to pay for services rendered.   That has not been the case for more than a decade.  Medicaid is now one the fastest payers.

 

Finally, and this is very important, Medicaid cannot just take away benefits.

To take away a benefit from everyone, there would have to be a legislative bill which would give people a way to be part of the process, and hopefully a solution.  To take away a benefit from an individual requires a notice, and the right of the beneficiary to have a hearing before a neutral judge. Whoever wants to take the benefit away has to prove that something changed.   One of our big concerns with Amendment 69 was that a board could vote away our benefits if funds were tight.   The board did not have any requirement to have input from the disability community – despite how deeply many of our lives depend on these services.

The Nevada legislature passed a bill that would allow Medicaid for all people in Nevada; those not poor would pay a premium.  Sadly, this was vetoed by the Governor of Nevada.  In Colorado, adults with disabilities have this option—we can buy into Medicaid but only if we have a job and are under 65.   If we lose our job and do not get another one in ten days, our Medicaid disappears.  Even though no one retires at age 65 anymore—this program stops at 65.   Other than those two gaping problems, the Medicaid Buy-In Program works well.  For many people with disabilities buying insurance is useless because we need what Medicaid offers, not what insurance offers.  While we may use doctors, need labs, and need hospitals, we really need LTSS and medical equipment.   Non-disabled people would not need LTSS but they could buy into the regular Medicaid package.

While this is not a national program, and a state-by-state approach carries some dangers of people with greatest needs moving to states with the best benefits, it is a much more appropriate solution than Medicare for all.   Medicare for all sounds good because Medicare does not have the stigma of Medicaid.   However, many advocates of Medicare for All are using this term out of a place of ignorance based on privilege.   Medicare for all will NOT solve our nations’ health care problems.   With a proper federally mandated floor regarding covered benefits, Medicaid for all is the best of all worlds.  Guarantee of health care with state control and allowing states to make reasonable rules and provide the benefits that best work for their populations.   People with disabilities have always been the canaries in the mine of health care.  The people promoting Medicare for All really need to listen to us—or at least, roll a mile on our wheels.

YAY–Settlement for victims of state mistreatment at Pueblo Regional Center

CCDC is proud of our good friends at the law firm of Kilner, Lane, and Newman for their victory. Good policy changes and some reparations for the victims. NO EXCUSE for the state taking this long to settle and not addressing these problems earlier. We hope next time clients in state custody say that something bad happened that the clients will be believed. We thank attorney Mari Newman for persevering to bring justice to the individuals with Developmental Disabilities and thank the two Arc Chapters serving clients for helping with this necessary litigation.
the office press release is below

PRESS RELEASE

Date: August 9, 2018

Re: Case against State for searches of people with mental disabilities ends with payment of $1,000,000 and policy changes

Plaintiffs and defendants today announced they have reached a satisfactory resolution to a 2016 lawsuit filed in federal district court, case No. 1:17-cv-00067-PAB-CBS. The lawsuit was based on the physical searches in March 2015 of Pueblo Regional Center residents with mental disabilities. The lawsuit alleged that the searches were non-consensual, violated the plaintiffs’ constitutional rights, and unlawfully discriminated against them based on their disabilities. The defendants denied that they committed any wrongdoing and maintained that the examinations were conducted in the interest of resident safety and were in response to concerns of underreporting of abuse and neglect. To resolve the case, the Colorado Department of Human Services (CDHS) has agreed to pay a settlement to the plaintiffs that totals $1 million, including attorney’s fees and costs.

CDHS has made numerous policy changes at the Pueblo Regional Center pursuant to changes in policies and procedures recommended by the Colorado Department of Public Health & Environment and the Centers for Medicare & Medicaid Services. These include: (1) a new Mistreatment Abuse Neglect and Exploitation (“MANE”) policy outlining how to report and address allegations of MANE; (2) removal of all blanket consent forms; (3) a new incident reporting policy; (4) development of a policy outlining resident rights; (5) Community Center Board (“CCB”) Human Rights Committee now reviews all rights suspensions, safety control/emergency control procedures, consents, and investigations; (6) all incidents are reported to the CCB and incidents of MANE are reported to law enforcement and Adult Protective Services (“APS”) as appropriate; (7) conducting daily multidisciplinary incident report review resulting in action plans for incidents and trends for the agency; (8) institution of monthly parent/guardian meetings; (9) educating parent/guardians on ways to file complaints; (10) implementing Quality Assurance/Performance Improvement (“QAPI”) committee; (11) providing leadership training for all new managers to be completed within the first year in their role; (12) direct care and nursing staff receive pay increases consistent with industry salary standards; (13) increase of staff, including 20 additional direct care staff positions; (14) reduction in staff working double shifts; and (15) institution of new lines of communication with staff, including monthly staff meetings and individual “stay” interviews.

Mari Newman

Killmer, Lane & Newman, LLP

The Odd Fellows Hall

1543 Champa Street, Suite 400

Denver, Colorado 80202

303-571-1000 (phone); 303-571-1001 (fax)

mnewman@KLN-law.com

www.KLN-law.com

Why We Want MEDICAID for all Not MEDICARE for all –Part I

By Julie Reiskin
October 11, 2017

Recently I was in a discussion with someone about health care policy, and there was shocked silence when I shared that CCDC does not support Medicare for All, and that we did not support Amendment 69 during the recent fall elections. “Aren’t you the people always protesting and carrying on about health care?” Yes-we are. “Aren’t you the ones that are most damaged by pre-existing condition exclusions, lifetime caps, etc., problems that a Medicare for All would solve?” Yes and No. We are most damaged by regressive policies such as pre-existing condition exclusions and lifetime caps—but NO-Medicare for All will not solve the problem.

Medicare is a great program -for basic health care like going to a doctor, getting a blood test, etc. We also absolutely want everyone, disabled or not, to have health care they need. However, Medicare only works today if you are healthy and have either Medicaid to go with it, lots of money, or can afford an excellent supplement. Moreover, Medicare has the most regressive policies that trickle down in a horrible way, making most health insurance unusable for people with disabilities. To top it off, Medicare does not cover what people with significant disabilities need most—which is long-term services and supports.

During our endless national health care debate during 2017, I have wanted to scream at the top of my lungs “I don’t need insurance, I need Medicaid.” Since screaming at the top of my lungs only serves to irritate my family or my staff (depending on where I am while screaming), I tweeted it a few times.

Why Medicaid for All instead?

Why Medicaid? Isn’t that the program for poor people—the horrible program that has no good doctors, where you have to wait forever to get anything done? Isn’t that a program with endless red tape?

No program is perfect, and we work closely every day with the Colorado Department of Health Care Policy and Financing or HCPF (pronounced hicpuff) to make it better. However, for our community Medicaid is the best program, and we want it for everyone. Allowing anyone to buy into Medicaid on a sliding scale rate would make the problems with Medicaid go away. Medicaid has a better benefit package, less red-tape, greater efficiency and much better policies than Medicare. At least in Colorado, this is the case. Medicaid is a federal-state partnership so the federal government sets some of the rules but states have flexibility. When a change is needed for any reason, including a change in medical technology, a change in known best medical practices, or the realization that a rule is making things worse not better, a change happens at the state level. With Medicare, a change requires an act of Congress—and we all know smoothly and effectively the U.S. Congress is working these days. Making a change at a state level usually requires bipartisan support at some level, public input and comment, showing budget neutrality, and going through a process. Change is not immediate but it is possible.

A few other differences:

1) Medicare covers 80% of medical benefits. If you are poor enough to have Medicaid, then Medicaid covers the other 20%. If you are rich enough to afford a good supplemental, then that pays the other 20%. Other people are stuck either with an insurance company that will (maybe) pay the 20% but will restrict what doctor and hospital you can use (along with numerous other impossible rules). Or these other people hope for the best and pay the 20% themselves. As long as one is healthy and has a reasonable income, this works. As soon as one is sick, it does not work. 20% of a lot is still a lot.

2) Medicare is incredibly bureaucratic and complex. The country is divided in regions, and Medicare contracts out “coverage decisions” for various benefits to insurance companies. There are “local coverage criteria” that are very hard to find and they may vary by region in some cases. Medicare rarely pre-authorizes anything. Patients get services; providers are expected to provide care. Weeks or months later, Medicare will decide what portion of this they will pay and what portion the patient must pay. They often deny services because they do not meet some abstract and hidden criteria. Medicaid applicants and recipients, on the other hand, have a right to appeal ANY adverse action. Medicaid recipients can even file an appeal if the agency does not act on a request in a reasonable amount of time. While a Medicaid appeal process may be a bit intimidating, there are people to help and even if you cannot find help, the state office of administrative courts tries to be fair to unrepresented parties. A Medicare appeal process is completely impossible and not even granted for every form of denial. Medicaid has timelines for all sorts of decisions—Medicare has no such timelines.

3) Medicare has antiquated and discriminatory requirements. The worst one is the homebound rule. This applies to home health care and durable medical equipment. This rule basically says that Medicare only covers this service to the extent the beneficiary is homebound. This means the person rarely leaves their home (except for medical appointments) and it requires great difficulty to leave the home.

This is the rule that drives many people with disabilities who have worked and paid into Medicare into Medicaid. With medical technology today, very few people are truly homebound.

Without Medicaid, people with disabilities on Medicare are denied necessary services. They cannot get a wheelchair that works outdoors, because Medicare only covers the kind of wheelchair needed for use in the home. People then get indoor chairs, but use them everywhere and get hit by cars, have the chairs break constantly, etc., because the chairs are not made for real use. Similarly, people with only Medicare are often denied home health care and what they can get is very much in the medical model. To add insult to injury, Medicare sets the stage for insurance; most private insurance companies follow Medicare rules regarding the homebound requirement. It is common medical knowledge that people who stay at home all of the time are less healthy than those that have an active life. Moreover, it is discriminatory and adds to isolation and segregation of people with disabilities. Because Medicare is a federal program, the American’s with Disabilities Act does not apply. Fortunately, the Olmstead Decision in which the Supreme Court said that state and local government programs must work to avoid policies that cause isolation and segregation of people with disabilities because they understood that isolation and segregation ARE discrimination. The ADA requires state and local governments to modify policies, practices and procedures to avoid discrimination – hence, they may NOT impose homebound criteria.

4) Medicare has no long-term services and supports. They do not even pay for nursing homes after 100 days (not that we want nursing home care). There are no services such as personal care, homemaker, supported employment, residential support, transportation, home modification, etc. These services are essential for people with disabilities to function in the community at the highest level of independence. Medicaid is the ONLY “insurance” that provides these essential services. While each state is different, all states offer some long term services and supports. We would support a national requirement for a basic level of LTSS. Most states allow for at least some “participant direction” of services. In Colorado, this means that some clients are allowed to control who comes into our homes, touches our bodies, and has access to every detail of our lives. We are given a budget and must live within it. Within the budget, we can decide what our aides are paid, when they should come and what they should do. This is much preferred than having an agency make these decisions and try to get numerous people services usually desired at the same time. Medicare has no such flexibility (of course they do not have any personal care benefits either).

Additional differences between Medicaid and Medicare and why CCDC advocates for Medicaid for All as the discussion of health care reforms ensues in America in the months to come will be covered in Part II of this blog next week.

Avoid Medicare Scams!

What should you do if someone calls and asks for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information? Hang up! It’s a scam.

Scam artists may try to steal your personal information by calling you and asking for your current Medicare Number to get your new Medicare card.

Medicare will never call uninvited and ask you to give personal information or money to get your new Medicare Number or card. Learn what to do if you get a suspicious call like this.

Remember: Your new Medicare card will automatically come to you in the mail. You don’t need to do anything, as long as your address is up-to-date with the Social Security Administration. If you need to update or verify your address, visit your My Social Security account.

Sincerely,

The Medicare Team

New Technology and Sidewalk Safety

Denver Public Works recently launched a one-year pilot permit program for dockless scooter and bike companies. CCDC enthusiastically supports new mobility options that provide safe, healthy, and convenient alternatives to driving. We also believe sidewalks are sacred spaces that should be preserved for people moving 5 mph or slower and remain free from obstructions that impede the movement of people with disabilities. We are advocating for Denver to change its policies to accommodate scooters where they belong – in bike lanes and other places where bicycles are allowed.

To help inform this policy change, if you experience a problem with scooters or other mobility devices on the sidewalk, please report it to the City. Examples include: device left in pathway; struck by device; or having to make a defensive move to avoid being hit. Report an incident to docklessmobility@denvergov.org.

 

Consumer Directed Attendant Suppport Services (CDASS) Implementation in Supported Living Services (SLS) Waiver

This post is a reproduction of the Policy Memo put out by the Colorado Department of Health Care Policy and Financing.

POLICY MEMO


POLICY MEMO NUMBER: HCPF PM 18-002
TITLE: CONSUMER DIRECTED ATTENDANT SUPPORT SERVICES (CDASS)
IMPLEMENTATION IN SUPPORTED LIVING SERVICES (SLS) WAIVER
SUPERSEDES NUMBER: N/A
ISSUE DATE: August 3, 2018
EFFECTIVE DATE: August 15, 2018
DIVISION AND OFFICE: BENEFITS AND SERVICES MANAGEMENT  DIVISION, OFFICE OF COMMUNITY LIVING
PROGRAM AREA: CONSUMER DIRECTION
APPROVED BY: GRETCHEN HAMMER
KEYWORDS: CONSUMER DIRECTION, SUPPORT LIVING SERVICES,
IMPLEMENTATION, CDASS


Continue reading “Consumer Directed Attendant Suppport Services (CDASS) Implementation in Supported Living Services (SLS) Waiver”

Summer 2018 CCDC Statewide Listening Tour

Come and join on our free Colorado Cross-Disability Coalition Statewide Listening Tour as we meet with people across our state to hear what you have to say.

The largest most experienced and trusted statewide disability rights organization in Colorado, CCDC, is conducting a Summer 2018 Statewide Listening Tour. It’s taking place in communities around the state and CCDC wants to hear from YOU!

During this tour, CCDC Executive Director Julie Reiskin will be available to provide the most up to date, accurate information on what has and has not changed at the Federal level regarding disability policy, what has and has not changed at the state level, and how you can make sure that your voice is heard.

We want to hear from people with disabilities (PWD) and our allies around the state about the most common issues that affect them in their communities. When possible, we want to help find possible solutions. CCDC will be revising Its strategic plan in 2019 and we want to ensure we focus on those issues most important to Coloradans with Disabilities. ‬‬

CONTACT: Please contact Karyn ReNae Anderson at  kranderson@ccdconline.org or 970–393-0170 if you
need any accommodations to participate as soon as possible but at least by (one week before events).

Scheduled dates and locations:

Link:  Aug 6th:   11am-1pm, Durango
Link: Aug 14th:   11am-1pm, Fort Collins
Link: Aug 14th:   3pm-5pm, Greeley
Link: Aug 17th:   3pm-5pm, Steamboat Springs
Link: Aug 22nd:   9am-1am, Fort Collins
Link: Aug 28th:   9am-1am, Glenwood Springs
Link: Aug 29th:   10:30am-12:30pm, Grand Junction
Link: Sep 11th:   1pm-3pm, Colorado Springs


Tour Details

Stop #5: Durango, Colorado

August 6, 2018:   11am-1pm, Durango Public Library, 1900 E 3rd Ave, Durango, Colorado 81301
Come and join us at the August 6 stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Durango.

Free lunch will be provided to guests.


Stop #6: Fort Collins, Colorado

August 14, 2018: 11am – 1 pm, Harmony Library, 4616 S Shields St, Fort Collins, CO 80526
Come and join us at the August 14 stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Ft. Collins.

Free lunch will be provided to guests.


Stop #7: Greeley, Colorado

August 14, 2018: 3pm – 5 pm, Lincoln Park Library, 1012 11th Street, Greeley, Colorado 80631
Come and join us at the August 14th stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Greeley.

Free snacks will be provided to guests.


Stop #8: Steamboat Springs, Colorado

August 17, 2018: 10 am – 12 pm, Bud Werner Memorial Library, 1289 Lincoln Ave, Steamboat Springs, CO 80487
Come and join us at the August 17 stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Steamboat Springs.

Free brunch will be provided to guests.


Stop #9: Aurora, Colorado

August 22, 2018: 9 am – 11 am, Aurora Fire Department Station #11, 2291 S Joliet St, Aurora, Colorado 80014
Come and join us at the August 22nd stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Steamboat Springs.

Free breakfast will be provided to guests.


Stop #10: Glenwood Springs, Colorado

August 28, 2018: 12:30 pm – 2:30 pm, Glenwood Springs Branch Library, 815 Cooper Ave, Glenwood Springs, Colorado 81601
Come and join us at the August 28th stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Glenwood Springs.

Free lunch will be provided to guests.


Stop #11: Grand Junction, Colorado

August 29, 2018: 10:30 am – 12:30 pm, Mesa County Workforce Center, 512 29 1/2 Rd, Grand Junction, Colorado 81504
Come and join us at the August 29th stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Grand Junction.

Free breakfast will be provided to guests.


Stop #12: Colorado Springs, Colorado

September 11, 2018: 1:00 pm – 3:00 pm, The Independence Center; 729 South Tejon St., Colorado Springs
Come and join us at the September 11th stop on our free Colorado Cross-Disability Coalition Statewide Listening Tour in Grand Junction.

Free lunch will be provided to guests.

Why the disability community does NOT want Medicare for All (Part II)

Why the disability community does NOT want Medicare for All (Part II)
By Julie Reiskin
October 23, 2017

To remind readers, Part I of this blog post from early October began with my statement that I was recently in a discussion with someone about health care policy. when I shared that CCDC does not support Medicare for All, and that we did not support Amendment 69 during the recent fall elections, there was shocked silence. “Aren’t you the people always protesting and carrying on about health care?” Yes-we are.

What follows are several more reasons not mentioned in Part I of this essay that compel CCDC to advocate for “Medicaid for All” as the way to go in health care reform ahead:

Medicaid has multiple requirements for public involvement.
There is a federally mandated advisory council that requires client involvement. In Colorado, just about every program has a robust public committee that complements other ways for the public to be actively involved. If one was so inclined, one could go to meetings about Medicaid policy with the state every day of the week. Nothing happens in Medicaid without an opportunity for public involvement. This may sound tedious unless your life is altered by how rules are made or enforced. This level of involvement is impossible on a national level.

As we all know, having lobbyists in DC opining on issues does not translate into understanding of how a policy affects the people. We are slowly learning about some of the very negative effects of the recently passed 21st Century Cures Act which imposes national mandates on states to impose on Medicaid clients and providers. The motivation may have been good, but the outcomes are bad. Working things out on a state level in terms of day to day management of programs works much better than trying to write rules or policies on a federal level for every single issue. Medicaid currently has national standards; those are clearly met. The details are often left to the states. If the states follow the rules, the states are not hassled. If they fail to follow the rules, they have to answer for that. Medicare, on the other hand, has no such accountability. There is no workable process to solve a problem with Medicare in terms of how it works on a day to day issue.

There are other differences.
Medicare in some areas does pay better than Medicaid, but if there were more money in Medicaid, rates could be raised. Over the past ten years, states have worked hard to get Medicaid rates at least close to the Medicare rate. Most providers accept Medicare, not all take Medicaid—again, if the population on Medicaid increased and rates were increased a bit, that would change. Some providers that do not take Medicaid have outdated information. Many years ago, it was true that Medicaid would take forever to pay for services rendered. That has not been the case for more than a decade. Medicaid is now one the fastest payers.

Finally, and this is very important, Medicaid cannot just take away benefits.
To take away a benefit from everyone, there would have to be a legislative bill which would give people a way to be part of the process, and hopefully a solution. To take away a benefit from an individual requires a notice, and the right of the beneficiary to have a hearing before a neutral judge. Whoever wants to take the benefit away has to prove that something changed. One of our big concerns with Amendment 69 was that a board could vote away our benefits if funds were tight. The board did not have any requirement to have input from the disability community – despite how deeply many of our lives depend on these services.

The Nevada legislature passed a bill that would allow Medicaid for all people in Nevada; those not poor would pay a premium. Sadly, this was vetoed by the Governor of Nevada. In Colorado, adults with disabilities have this option—we can buy into Medicaid but only if we have a job and are under 65. If we lose our job and do not get another one in ten days, our Medicaid disappears. Even though no one retires at age 65 anymore—this program stops at 65. Other than those two gaping problems, the Medicaid Buy-In Program works well. For many people with disabilities buying insurance is useless because we need what Medicaid offers, not what insurance offers. While we may use doctors, need labs, and need hospitals, we really need LTSS and medical equipment. Non-disabled people would not need LTSS but they could buy into the regular Medicaid package.

While this is not a national program, and a state-by-state approach carries some dangers of people with greatest needs moving to states with the best benefits, it is a much more appropriate solution than Medicare for all. Medicare for all sounds good because Medicare does not have the stigma of Medicaid. However, many advocates of Medicare for All are using this term out of a place of ignorance based on privilege. Medicare for all will NOT solve our nations’ health care problems. With a proper federally mandated floor regarding covered benefits, Medicaid for all is the best of all worlds. Guarantee of health care with state control and allowing states to make reasonable rules and provide the benefits that best work for their populations. People with disabilities have always been the canaries in the mine of health care. The people promoting Medicare for All really need to listen to us—or at least, roll a mile on our wheels.

Why the disability community does NOT want Medicare forAll (Part I)

 

Why the disability community does NOT want Medicare forAll (Part I)

By Julie Reiskin

October 11, 2017

Recently I was in a discussion with someone about health care policy, and there was shocked silence when I shared that CCDCdoes not support Medicare for All, and that we did not support Amendment 69 during the recent fall elections.  “Aren’t you the people always protesting and carrying on about health care?”   Yes-we are.  “Aren’t you the ones that are most damaged by pre-existing condition exclusions, lifetime caps, etc., problems that a Medicare for All would solve?”  Yes and No.  We are most damaged by regressive policies such as pre-existing condition exclusions and lifetime caps—but NO-Medicare for All will not solve the problem.

Medicare is a great program-for basic health care like going to a doctor, getting a blood test, etc.   We also absolutely want everyone, disabled or not, to have health care they need.  However, Medicare only works today if you are healthy and have either Medicaid to go with it, lots of money, or can afford an excellent supplement.   Moreover, Medicare has the most regressive policies that trickle down in a horrible way, making most health insurance unusable for people with disabilities.    To top it off, Medicare does not cover what people with significant disabilities need most—which is long term services and supports.

During our endless national health care debate during 2017, I have wanted to scream at the top of my lungs “I don’t need insurance, I need Medicaid.”  Since screaming at the top of my lungs only serves to irritate my family or my staff (depending on where I am while screaming), I tweeted it a few times.

Why Medicaid for All instead?

Why Medicaid?  Isn’t that the program for poor people—the horrible program that has no good doctors, where you have to wait forever to get anything done?  Isn’t that a program with endless red tape?

No program is perfect, and we work closely every day with the Colorado Department of Health Care Policy and Financing or HCPF (pronounced hicpuff) to make it better. However, for our community Medicaid is the best program, and we want it for everyone.  Allowing anyone to buy into Medicaid on a sliding scale rate would make the problems with Medicaid go away.  Medicaid has a better benefit package, less red-tape, greater efficiency and much better policies than Medicare.  At least in Colorado, this is the case.   Medicaid is a federal-state partnership so the federal government sets some of the rules but states have flexibility.  When a change is needed for any reason,including a change in medical technology, a change in known best medical practices, or the realization that a rule is making things worse not better, a change happens at the state level.   With Medicare, a change requires an act of Congress—and we all know smoothly and effectively the U.S. Congress is working these days.   Making a change at a state level usually requires bipartisan support at some level, public input and comment, showing budget neutrality, and going through a process.  Change is not immediate but it is possible.

A few other differences:

1) Medicare covers 80% of medical benefits.  If you are poor enough to have Medicaid, then Medicaid covers the other 20%.  If you are rich enough to afford a good supplemental,then that pays the other 20%.  Other people are stuck either with an insurance company that will (maybe) pay the 20% but will restrict what doctor and hospital you can use (along with numerous other impossible rules).  Or these other people hope for the best and pay the 20% themselves.   As long as one is healthy and has a reasonable income, this works.  As soon as one is sick, it does not work.  20% of a lot is still a lot.
2) Medicare is incredibly bureaucratic and complex.  The country is divided in regions, and Medicare contracts out “coverage decisions” for various benefits to insurance companies.  There are “local coverage criteria” that are very hard to find and they may vary by region in some cases.  Medicare rarely pre-authorizes anything.  Patients get services; providers are expected to provide care.  Weeks or months later, Medicare will decide what portion of this they will pay and what portion the patient must pay.  They often deny services because they do not meet some abstract and hidden criteria.   Medicaid applicants and recipients, on the other hand, have a right to appeal ANY adverse action.  Medicaid recipients can even file an appeal if the agency does not act on a request in a reasonable amount of time.  While a Medicaid appeal process may be a bit intimidating, there are people to help and even if you cannot find help, the state office of administrative courts tries to be fair to unrepresented parties.  A Medicare appeal process is completely impossible and not even granted for every form of denial.   Medicaid has timelines for all sorts of decisions—Medicare has no such timelines.
3) Medicare has antiquated and discriminatory requirements.  The worst one is the homebound rule.   This applies to home health care and durable medical equipment.   This rule basically says that Medicare only covers this service to the extent the beneficiary is homebound.  This means the person rarely leaves their home (except for medical appointments) and it requires great difficulty to leave the home.

This is the rule that drives many people with disabilities who have worked and paid into Medicare into Medicaid.  With medical technology today, very few people are truly homebound.

Without Medicaid, people with disabilities on Medicare are denied necessary services.   They cannot get a wheelchair that works outdoors, because Medicare only covers the kind of wheelchair needed for use in the home.  People then get indoor chairs, but use them everywhere and get hit by cars, have the chairs break constantly, etc., because the chairs are not made for real use.  Similarly, people with only Medicare are often denied home health care and what they can get is very much in the medical model.   To add insult to injury, Medicare sets the stage for insurance; most private insurance companies follow Medicare rules regarding the homebound requirement.  It is common medical knowledge that people who stay at home all of the time are less healthy than those that have an active life.  Moreover, it is discriminatory and adds to isolation and segregation of people with disabilities.  Because Medicare is a federal program, the American’s with Disabilities Act does not apply. Fortunately, the Olmstead Decision in which the Supreme Court said that state and local government programs must work to avoid policies that cause isolation and segregation of people with disabilities because they understood that isolation and segregation ARE discrimination.   The ADA requires state and local governments to modify policies, practices and procedures to avoid discrimination – hence, they may NOT impose homebound criteria.

4) Medicare has no long-term services and supports.  They do not even pay for nursing homes after 100 days (not that we want nursing home care).  There are no services such as personal care, homemaker, supported employment, residential support, transportation, home modification, etc.   These services are essential for people with disabilities to function in the community at the highest level of independence.   Medicaid is the ONLY “insurance” that provides these essential services.   While each state is different, all states offer some long term services and supports.   We would support a national requirement for a basic level of LTSS.   Most states allow for at least some “participant direction” of services. In Colorado, this means that some clients are allowed to control who comes into our homes, touches our bodies, and has access to every detail of our lives.  We are given a budget and must live within it.  Within the budget, we can decide what our aides are paid, when they should come and what they should do.  This is much preferred than having an agency make these decisions and try to get numerous people services usually desired at the same time.  Medicare has no such flexibility (of course they do not have any personal care benefits either).

Additional differences between Medicaid and Medicare and why CCDC advocates for Medicaid for All as the discussion of health care reforms ensues in America in the months to come will be covered in Part II of this blog next week.

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