In Washington State, more than 125,000 people are eligible for both Medicare and Medicaid. About half of these individuals are younger people with disabilities and half are people age 65+. They tend to be very low-income with a high level of health and social service needs.
See Also: Health Care Reform: What’s in Effect, What’s Still to Come
Sadly, care for these individuals is often very fragmented and uncoordinated. Medicare pays for some things, Medicaid for others. Their care is fragmented - with little or no coordination between their different doctors, home care workers or others in the community who help them with an array of long term care, mental health or other social service needs. No one is paying attention to the full picture of their needs.
To improve the quality of their care and reduce costs the State of Washington is taking advantage of a provision of the Affordable Care Act. The health reform bill passed by Congress acknowledged the need to improve care for this population and has awarded 15 states including Washington with funding to plan for improvement.
Right now the Washington Aging and Disability Services Administration and the Health Care Authority are in the midst of gathering input and making a plan. The goal is to integrate care by blending funding sources and establishing one entity that will be responsible for the full range of care needs. The idea is that by coordinating care more effectively people have a better chance of getting what they need, improving their health and avoiding expensive trips to the emergency room or hospital.
This change is likely to involve a move towards a managed care model for long term care. The challenge for consumer advocates is ensuring that in doing so we make sure important protections are in place so that people are not denied needed services, restricted from choosing providers they prefer or unclear on who to turn to if there is a problem.
There are few models to learn from when it comes to managed long term care and many questions to be answered. To be successful, the state will need to find effective ways to hold managed care companies accountable with evidence based systems to measure outcomes, clear metrics and proactive quality assessment.
Improving our states long term care system – starting with the dually eligible population – is a never ending journey. We have made a lot of progress in Washington to ensure people have the choices and options to stay in their own homes as they age. And we have more to do to ensure that the full range of their health care needs are comprehensively addressed.