Elder Law Attorney Agrees Managed Care May Help Quality of Care for California Seniors
Palo Alto, CA (Law Firm Newswire) June 19, 2013 – California is planning to try a managed health care system to unify Medicare and Medi-Cal.
While dual coverage sounds like a good thing, lower income seniors in California who are eligible for both Medicare and the state's version of Medicaid, known as Medi-Cal, are facing a serious lack of coordinated care. Medicare, the federal program for seniors, is not designed to work in tandem with Medi-Cal, the federal-state program for low income individuals, the way the state is currently using the system. The ensuing mistakes, delays and administrative issues are all costing the state a significant amount of money.
"The state is attempting to combine the services offered by Medicare and Medi-Cal into one streamlined program which would use one administrative hub, hopefully limiting the amount of confusion," says elder law attorney Michael Gilfix. Not only would health care be overseen by one entity, but also social services, and in-home health aides who can assist with mealtimes and bathing, known as "activities of daily living."
California Gov. Jerry Brown has stated that he believes the change in administrative approach will help the more than one million seniors and infirm residents of the state, including the people who spent their savings to be able to qualify for Medi-Cal coverage. Brown also says that he hopes the reforms save big for the state; it is estimated that as much as five hundred million dollars may be saved from the state's health program budget.
Critics have voiced concern that the managed care plans may be overburdened, leaving the patients with substandard care. Medicare pays for medical visits, short-term hospital stays and prescription medications. It is in a patient's hands to find and choose their doctor and get medication. If they are also low-income, Medi-Cal covers the co-payments and deductibles Medicare charges, and pays for the patient's long-term care, such as nursing home care.
But that dual coverage means that if the patient resides in a nursing home, but needs to go to the hospital, or only has a short nursing home stay and then returns home,they will likely not have continuity of care, as different doctors and caregivers work under different systems. And if they also need social services, the amount of mistakes, confusion and conflicting information for care is further compounded: social services is overseen by the county, adding in a third administrative entity.
Managed care will have one health plan which coordinates all of each patient’s services, with financial incentives to keep patients out of nursing homes and hospitals, using in-home care when possible. The shift to managed care is expected after Oct. 1, 2013, starting with a three-year experimental program in Southern California.
To learn more, visit Gilfix & La Poll Associates LLP at http://www.gilfix.com/.
Gilfix & La Poll Associates LLP
2300 Geng Rd., Suite 200
Palo Alto, CA 94303
Telephone: (650) 493-8070
Facebook: Like Us!
- Gilfix & La Poll attorneys speak at NAELA Summi
Attorneys Michael Gilfix and Mark R. Gilfix of Gilfix & La Poll Associates appeared as featured speakers at two sessions during the 2016 National Academy of Elder Law Attorneys Summit in Newport Beach, California, on January 28 and 29. Michael Gilfix is one of NAELA’s original founding members. They addressed audiences of more than 100 […]
- How an IRA Trust can help avert disaster
By Attorney Elijah Keyes A father designated his son and daughter as the beneficiaries of his large retirement account. The daughter’s husband was physically abusive and the couple had been considering divorce. The father was adamant that his son-in-law receive nothing from his estate. After a very healthy life, the daughter was diagnosed with stage […]
- Home Care and Financial Abuse
Over 8 million older Americans receive care at home or in facilities by strangers. Some caregivers are trained and managed by home health care agencies. Others are hired privately in an effort to save money. Privately hired caregivers may charge as little as $12 or $14 per hour. Caregivers hired through an agency may be […]
- Avoiding fights over inheritance with revocable living trusts
When parents pass away without clear instructions in place about how to divide their assets upon their death, they may leave family members battling over inheritance for years. Such fights can cause rifts that are sometimes impossible to heal. A will contains detailed instructions on how a person wants their assets, such as family heirlooms […]
- Women bear the brunt of costs for Alzheimer’s care, says study
A study by Emory University researchers has found that women shoulder six times the cost of Alzheimer’s disease care than men. The greater burden in expenses is mainly due to the informal care that women provide to family members who have the degenerative brain disorder. Researchers examined three factors to calculate Alzheimer’s care costs using […]