Many states do a poor job of regulating Medicaid fraud because it is a not a simple matter economically. After all, for ever dollar Medicaid brings into a state, there is a federal matching dollar hat the state receives. Some states even overpay Medicaid providers, collect matching federal funds, and collect kickbacks of overpayments, thus becoming part of the fraud problem.
The question then becomes, what is the sense behind turning the oversight of Medicaid over to the same government that is participating in the fraud? Their actions have created long waiting lists, rationing of care and poor delivery of not enough care, again controlled by the government.
There is another side to the issue, however. What happens when you need to make the numbers work? It’s important to look at the major problem. There are many honest and caring physicians who try to help as many individuals on Medicaid as possible. The problem is that even the busiest physicians that take Medicare can’t take more than about 28% of their caseload in Medicaid patients, they can’t afford to stay in business because the amount they are reimbursed is lower than the services provided. Therefore, if there are too many Medicaid patients seeing a particular doctor, he loses money until he can’t afford to stay in business any more.
We haven’t even talked about the number of children covered by Medicaid for various reasons. There are over 25 million kids that have various forms of Medicaid coverage. There are Targeted Case Workers and Case Management through Medicaid Rehabilitative Services who do all they can to deal with children’s’ physical and mental disabilities – getting help and services for them while keeping expenses to Medicaid and to physicians under control. A federal-state partnership that exists now to cover these expenses could be eliminated if some politicians get their way.
Looking at both sides, the hope is that the politicians will be able to work with the expenses while remembering that these issues are not only about finances, but at the heart of the issues are children and adults with vulnerabilities and disabilities that depend on the Medicaid system to help keep them well.
Walgreens Drug Stores agreed today to pay $35 million to the federal government for fraudulent activities regarding three prescription drugs. What was at the heart of the case was that Walgreen was switching out the prescribed drugs for more expensive brands and by switching these, they substantially increased the amount of money that Medicaid reimbursed them, thus substantially increasing their profits.
Medicaid recipients were unaware of this, and there has been no disclosure in the suit that any recipients were harmed, however, switching medication is not harmless. Just because it seems so far that nobody was hurt or killed in this situation, there are severe penalties for these practices because serious risks do exists. Plus, switching medications for profit is simply put, illegal.
Switching medications in this way is a violation of state and federal regulations that are designed to protect patients. In addition, pharmacies subject themselves to triple damages, civil penalties and attorneys’ fees. Usually, this, plus the willingness of insiders to report such fraudulent activities helps keep pharmacies in line with regulations, however, this case against Walgreens should be a warning that the government will pursue fraud aggressively.
For Medicaid recipients, it is important that you know that this what Walgreens did in this case is not the same as the pharmacy calling your doctor and asking if the medications could be switched. That is a practice that pharmacies use if they are trying to correctly fill a prescription with a substitute generic medication. In the Walgreens case, thousands of prescriptions were replaced without notifying anyone, and that is totally against regulations.
This case should let you know that if you receive Medicaid benefits, there are agencies looking out for your welfare and trying to protect you, and reassure you that most pharmacies try to help their clients by filling the right prescriptions and doing the right thing.
The Senate and House have been grappling with the budget for months now. There have been many different viewpoints included some pointed and heated debates with the President, with promises of vetoes.
Yesterday, the Senate passed a $3.1 Trillion budget which will pass the burden of balancing the budget and dealing with tax issues that will likely affect Medicare and other important benefits. As the candidates for President assess their plans and responsibilities, as well as their priorities, they will need to be thinking about how to balance the budget while saving essential programs and services such as Medicare.
The annual budget debate in Congress provides for a non-binding resolution that opens the way for later bills that will affect taxes and, of course, Medicare and other programs. For now, though, the budget offered by Congress will extend some tax breaks for businesses, and will prevent doctors from having to absorb the proposed cuts in their Medicare payments.
Though this is a band aid for now, it is not a way to solve the issues in the long term. Medicare recipients could be hit with less reimbursement to doctors, less procedures that are covered and stricter guidelines and oversight as to what is actually “medically necessary.” Of course, services and procedures must be considered “medically necessary” in order to have Medicare pay for them.
The other issue regarding cutting repayment to doctors is also an issue that will need to be addressed when the next President grapples with the budget. Though there is a delay for now, the issue will be right back on the table and needs to be dealt with as efficiently as possible so that the issue is resolved quickly and fairly and everyone involved in the Medicare system – especially patients and doctors – can move forward with more certainty.
It will be important to watch and see what happens during and after the election and see how things pan out. Though the picture does not look rosy, there are a number of ways to help the Medicare system and a number of ideas that are being considered.
For now, at least, benefits are staying as is, and will be dealt with, most likely in 2009, after the political hoopla settles down and Washington get back to the real nuts and bolts business of running the government.
Individuals with terminal illnesses have the right to choose their end-of-life care. That has long been an issue that has received attention from individuals, families, the public, hospitals, insurance companies and more.
The Center for Medicare and Medicaid Services (CMS) has now put this information in writing, including it in the outline of a new regulation regarding this issue. CMS will publish and release the outline later this year.
Previously, there was no specific language regarding individual patient’s rights in regulations. This new regulation is the first update since 1983, when Hospice care and end-of-life rights were not as wide an issue as they have become now.
Many Hospice patients are already very involved in their rights, care and treatment, as well as their wishes as they come to the end of their life, however, now that there is a specific regulation with language in place which details and reinforces those rights, there is stronger protection for those who might want to explain their wishes but need the support to do so.
Some of the rights of individuals involved in Hospice care or palliative care include participation in their treatment plan, the right to effective pain management, the right to refuse treatment and the right to choose their own physician.
Hospice care can be chosen when a patient decides that curative care is no longer an option for them. By choosing Hospice care, they are choosing to receive care that will provide comfort and care to themselves and sometimes to the family members, as well. This type of care can be provided at home as well as in an inpatient setting. Nearly one million Medicare beneficiaries are receiving Hospice care at any given time.
Updating the regulation and reinforcing patients rights – on paper – is an important step in making sure that the individuals who are making decisions about end-of-life issues do not have to struggle with the emotional issues involving deciding on care and receiving support.
After taking a long look at the way payments to Medicare in many Florida counties are paid, there seem to be a number of inequities. Payments in Miami-Dade counties are 38% higher than in a number of counties and 50% higher than in 24 other counties. In addition, the other counties receive fewer benefits than plans in Miami-Dade.
Somehow this has a lot to do with the way that the counties are districted. To help adjust the situation, next year Miami-Dade will receive a 13% payment increase, while other counties only receive 3% to 4% increases. This will be the beginning of trying to make the Medicare situation more equitable throughout the state.
Florida is not the only state that struggles with some of these issues, however, they are, at present, addressing the issues and tackling them to make the financial ramifications of premiums and payments much more fair and equitable.
Representative Robert D. Wexler, a Democrat, is expected to legislation next week that will change the way that Medicare calculates payments to private health plans in various counties. To this point, has mandated that payments are calculated on a county basis. Miami-Dade has been billed more on a per person basis, leading to the difference in the rates for Miami-Dade, vs. the other counties in question.
Wexler’s proposal would require HHS to close the payment gap until Palm Beach County’s rates are within 3% of Miami-Dade’s by 2012. The bill would lower the Miami-Dade payments and use that money to raise payments in Palm Beach County.
Some of this may sound complicated, but the main issue – especially for the people of Florida – is that there will be a fair and equal distribution of benefits for everyone. This is actually important and trendsetting, because Los Angeles may be the next place they look.
When elderly individuals go into along term care facility or a similar facility and self pay, the cost can be astronomical. Making sure that the person is comfortable, well cared for, in a clean environment and positive atmosphere is not a low budget issue. What happens, though, when a private pay individual converts to Medicaid?
Well, one would think that because all of the payments are now guaranteed, albeit possibly lower, that these facilities that have been raking in money from these individuals and their families, that they would leave grandma, grandpa or aunt Minnie in comfort and without worry without changing a thing.
Unfortunately, this doesn’t always happen. In fact, there is an investigation taking place in New Jersey regarding the company Assisted Living Concepts, owner of eight assisted living homes in southern New Jersey. The investigation was started by the Public Advocate for the state, who has filed papers against the company because of their alleged practice of discharging the elderly when they change from self pay to Medicaid.
Public Advocate Ronald K. Chen is asking for the names, admission and discharge summaries, as well as contact information for every resident of the company who is or has been a Medicaid beneficiary.
Chen says that the investigation was sparked because there is an indication that this company “is placing elderly vulnerable residents at risk by displacing them from their homes in violation of ALC’s state license. Our primary concern is to protect the safety well being and peace of mind of these residents.”
The representative of Assisted Living Concepts, Laurie Bebo, who is also the CEO of the company, refuses to cooperate with the subpoena and states that the company does not have any Medicaid conditions in their license; therefore, they do not have to honor Medicaid patients.
Chen says that state licenses for all eight facilities stipulate that at least 30% of the residents of each of the facilities are to be Medicaid eligible and no resident would be discharged because or if they spent all their money.
Assisted Living Concepts operates more than 200 assisted living residences in 17 sates, containing more than 8,000 units, so this is no small issue. New Jersey may just be the tip of the iceberg.
When elderly individuals go into a long term care facility or assisted living facility and self pay, the cost can be astronomical. Making sure that the person is comfortable, well cared for, in a clean environment and positive atmosphere is not a low budget issue. What happens, though, when a private pay individual converts to Medicaid?
Well, one would think that because all of the payments are now guaranteed, albeit possibly lower, that these facilities that have been raking in money from these individuals and their families, that they would leave grandma, grandpa or aunt Minnie in comfort and without worry without changing a thing.
Unfortunately, this doesn’t always happen. In fact, there is an investigation taking place in New Jersey regarding the company Assisted Living Concepts, owner of eight assisted living homes in southern New Jersey. The investigation was started by the Public Advocate for the state, who has filed papers against the company because of their alleged practice of discharging the elderly when they change from self pay to Medicaid.
Public Advocate Ronald K. Chen is asking for the names, admission and discharge summaries, as well as contact information for every resident of the company who is or has been a Medicaid beneficiary.
Chen says that the investigation was sparked because there is an indication that this company “is placing elderly vulnerable residents at risk by displacing them from their homes in violation of ALC’s state license. Our primary concern is to protect the safety well being and peace of mind of these residents.”
The representative of Assisted Living Concepts, Laurie Bebo, who is also the CEO of the company, refuses to cooperate with the subpoena and states that the company does not have any Medicaid conditions in their license; therefore, they do not have to honor Medicaid patients.
Chen says that state licenses for all eight facilities stipulate that at least 30% of the residents of each of the facilities are to be Medicaid eligible and no resident would be discharged because or if they spent all their money.
Assisted Living Concepts operates more than 200 assisted living residences in 17 sates, containing more than 8,000 units, so this is no small issue. New Jersey may just be the tip of the iceberg.
AARP is working hard to protect Medicare recipients from extreme Medicare premium increases. AARP volunteers delivered over 20,000 petitions to Texas Senator Kay Bailey Hutchison and John Cornyn in Dallas and Austin protesting the fact that premiums have doubled since the year 2000.
Congress must deal with this issue by June 30th to make sure that Medicare recipients are not denied access to physicians and the essential medical services their physicians provide. Though Medicare recipients have continued to pay their share, even when they have felt it has become an unfair share, things are now out of control, according to recipients and to AARP. It is time to deal with this issue – before time runs out – and it is essential to make sure that doctors can continue to treat their patients and patients can continue their access to and relationships with their doctors.
Though this particular situation and protest is taking place in Texas, where all Texans are under the strain of high prices for everything from bread to gasoline, Texas is not the only state that is dealing with Medicare struggles. Too many Medicare beneficiaries in Texas – and around the country – who cannot afford basic necessities, are now being forced to pay Medicare premiums that often put the beneficiaries in a situation where they have to choose between Medicare and the necessities of life.
AARP Texas President has stated that AARP is “asking the Senators to fix the problem of getting physicians paid and not just vote to raise premiums.” AARP has pointed out that Congress has simply been using band aids and not real long-term fixes to take care of Medicare issues. These fixes seem to continue to include increases in premiums to Medicare recipients rather than long term solutions that will not penalize the very individuals that these benefits are supposed to help.
Time will tell what will happen in Texas and how Congress will treat the 20,000 petitions. AARP, Congress and Medicare recipients will not only be watching Texas results, but, in these difficult times, they will be watching the Medicare issues throughout the country.
The sheriff in Isabella County, central Michigan issued a warning for seniors and individuals with disabilities about yet another scam aimed at them.
This scam has callers contacting Medicare recipients telling them that the caller is from Medicare and has called to warn the recipient that their benefits will cancel in 30 days. The callers also tell recipients that in order to keep their Medicare benefits, they need to give the callers personal information bank account numbers, social security numbers and Medicare number. Callers will say that there is no cost for updating this information.
These types of scams are becoming more and more common throughout the country. They prey on the elderly and on individuals with disabilities, and they sound so authentic that they are often able to get the information they are asking for. Then they use the information in a fraudulent way.
It is important that no matter where you live, you Do NOT fall for these scams and do not give out ANY personal information – especially social security numbers, bank account numbers and Medicare or other information that should remain private and protected.
It is important to know that actual Medicare or Social Security representatives will NEVER ask you for personal information and they will NEVER ask you to pay them over the phone. Medicare sends out information about bills and statements to recipients if there are any amounts due. Most of the time the amount would be set up in advance to be deducted from your ban account and you would receive statement in the mail showing the deduction.
If someone calls you trying to get information that is private, do not give it to them. Try to get their name and number and report them to your local police department. If you happen to live in Isabella County Michigan, call your local Sheriff’s office at 1-989-772-5911.
Most of us live our lives without too many emergencies to interrupt us. As a result, we have a tendency to get pretty comfortable and not be totally prepared in the event of certain emergencies – especially medical emergencies.
This can put us in a mess if we are suddenly faced with a medical situation where people – such as our doctors or hospital – need pertinent information from us to treat us. For example, we might break our leg, which in and of itself seems simple to deal with.
However, what if we are taking medicine for blood pressure, diabetes, heart issues or blood thinners? All of these medications can have an effect on how the doctors in the emergency room choose to treat us. They can also have a huge effect on our health.
If the doctors don’t know what medicines we are taking or how much, they could possibly give us conflicting medicine which could cause serious health issues.
There is an easy solution to this issue. Write it all down. A great suggestion is for you or a friend/family member to write down all your medications, the doses, and the times you take them. Include over-the-counter medicines, such as Tylenol or allergy medication. In addition, write down your blood type, religious preference, doctor’s name and phone number and an emergency name and phone number plus any allergies you might have. Put all of this information on one sheet of paper and fold it and put it in your wallet. In addition, give an extra copy to a friend or relative, as well as keeping one copy on a magnet on your refrigerator so it will be easy to find in an emergency.
Chances are that you won’t need to use this handy little paper, but in the event that it is necessary, it will keep your doctors informed and will keep you safe.
There is a lot of talk these days about reverse mortgages, especially for retirees. There have been good reports and bad.
This is how a reverse mortgage works. If you are 62 years old or older, you can apply for a reverse mortgage as long as you own your house outright or owe very little on it. The idea is that you would have the cash to be able to use if you needed it.
With a reverse mortgage there are no monthly repayments, so the good news is that you don’t risk losing your home. The way this works is that equity is taken out of the home each month and paid to the borrower. The borrower keeps the deed to the property – the lender does not get the deed like they would in a regular mortgage.
The program is federally insured, so that the government guarantees that the borrower will receive every bit of money they are entitled to no matter what. If the lender goes broke or can’t pay, the government will pay the money to the borrower. There are also government rules about how much money can be charged for fees. Period. There are several different ways that the payments can be made, depending on what the borrower chooses.
The important thing is that the payments are tax free, so they don’t affect your Social Security or Medicaid.
There are a few negative issues with reverse mortgages. There is a ceiling on the amount that can be borrowed. Up front costs can be high. If you are on SSI or Medicaid you can lose benefits if you don’t spend down your entire loan amount every month.
If you are thinking of opting for a reverse mortgage these are some important things to think about. There are others, as well, so be sure to do some research. Talk to an attorney, accountant and mortgage broker that you know and trust. Check the internet for reverse mortgages. Call AARP. Discuss and research the topic thoroughly so that you will feel comfortable with your decision.
Reverse mortgages have become extremely popular and are an excellent choice if you are in the right situation to take advantage of them.
Hospice has come to be synonymous with helping people at the end of their lives die with dignity. It is not an easy situation. It is difficult for the patient, difficult for the family and difficult for the hospice provider.
The majority of hospice providers are caring people who extend themselves to patients and their families at the worst time imaginable. Since illness at the end of one’s life is not an exact science, even patients who would seem to have weeks or months to live can defy the odds and live much longer. This is, of course, a very positive situation for many families, as long as the patient is not suffering.
As if all of this is not enough, picture payment issues with Medicare. For instance, imagine a hospice that is providing care for a number of people – patients who have lived longer than Medicare will pay. What should a provider do? Stop taking care of these patients? Once the hospice has obtained the allotted number of extensions and is out of funding, what should they do with the patient that is still holding on to life?
This is a question that has been taken to Capitol Hill and is being examined carefully. A number of hospice administrators are trying to sort out this issue. There are some who are millions in debt to Medicare – in fact, Medicare has told them that they need to pay up or declare bankruptcy. This is a very difficult situation for individuals to be in when they have spent their lives trying to help and care for patients and families who are suffering one of the ultimate issues humans can go through.
It will be interesting to see how this situation is solved and what happens to this most essential and delicate service that is rendered at the most vulnerable time in a family’s life. Hopefully there will be a way to address this issue and solve this problem without compromising caregivers or the people they serve.
A Medicaid plan proposed by the Division of Medicaid and the state hospital association in Mississippi was passed by the Mississippi Senate today. The debate took 24 hours until it was passed, and it still has to be discussed in the House on Thursday, 5/29.
The Senate spent the 24 hours discussing how the bill – or not passing the bill – would affect hospitals and patients in the state. Though there will be a 90 million dollar deficit, it has still been decided that this would be a better choice than not passing the bill.
For one thing, though there is a deficit, there will be taxes that offset the deficit. The hospitals will pay out taxes, but will receive more in return, so, in the end, the hospitals, the individuals that use the hospitals and the state itself, will end up better for the situation.
The hospitals in the state all have to pay an assessment tax to offset the shortfall of the 90 million dollars, but the federal government will pay the hospitals back at a rate of three to one. Therefore, for every three dollars that each hospital pays, they will receive two dollars in return in federal funds. The money is paid back to each hospital depending on the number of Medicaid patients they provide services to. The Lieutenant Governor of Mississippi, Phil Bryant has said that “this will help fund not only next year but in years to come.”
Though most hospitals will receive the money back, seventeen hospitals will have a shortfall, which will be reimbursed by the hospital association. State Senator Terry Burton says, “I think taxpayers have benefited as a result of this.”
Thursday will tell whether the House agrees with the Senate and passes the bill to help hospitals and patients who use them.
There have been quite a few accusations and questions about the Bush administration with regard to many issues. There’s the war, gas prices, the economy (in general) and now Medicaid tricks. President Bush has been trying for some time to go around Congress and push through a Medicaid regulation that would eliminate reimbursements to public hospitals, costing money, cutting services and probably costing lives. The sad part about this is that Congress made it clear that this was not to be even dealt with for at least on year because Congress had passed a moratorium on the resolution stating that not even the President could change it.
Unfortunately, President Bush and his administration tried to use a “rush through rule” to ignore the decision that Congress made. The Bush Administration tried to alter, and then process out – the moratorium. Fortunately for the public and for the public hospitals that serve the public, a Federal Judge was not fooled, nor was he impressed about what the Bush Administration tried to do. As a result, Federal Judge James Robertson of the United States District Court for the District of Columbia put a stop to this less than honest and sneaky move.
It is certain because of this action by the Bush Administration, that this is not the last we will hear about the situation. I addition, there are other cuts looming on the horizon. There are seven cuts that are proposed that Congress is trying to stop, or at least, stall until they can be discussed further. These cuts, if approved, could cost the states a tremendous amount of money and possibly destroy some medical care providers. Not to mention the fact that services would be cut for those who need the services most.
We are told all our lives that it is essential to follow the rules and obey the laws. This should include the President and members of his administration, no matter who they are, what they believe or whether they agree with decisions or not. The unfortunate situation is that individual citizens without special privileges pay sometimes serious consequences when they do not. It is good to see the example of a judge who was willing to stand up for an important decision that Congress made to protect the people who need it most.
There are numerous complaints about government agencies not communicating with one another and not working together. Some of these complaints make it clear that because of this lack of communication people have been hurt or killed, lost money or property and have often ended up in crisis.
There is some good news for Medicare recipients. The Food and Drug Administration (FDA) and Medicare will be working together to help keep recipients safer. Both the FDA and Medicare have huge databases. Medicare’s databases contain a tremendous amount of information regarding claims, which include medication. The agencies have determined how they can use the databases to explore and address problems with medications and medical devices and equipment that are discovered while they are new on the market. This computerized early-warning system is being designed to keep people healthy and save lives. In addition, the system will save money by recognizing negative reactions quickly, look at patterns that lead to hospitalizations and work to isolate medications that are causing or increasing health problems. With all this at work together, this should eliminate some hospitalizations and other medical expenses, saving money for recipients, for Medicare and for all involved in the system that tries to keep people well.
This new system will keep individual records private. Only information regarding medical issues will be shared, but the identity of the individual will be kept private. The FDA has a current early warning system, but it relies on self-reporting by patients and doctors, which is not accurate, and which also does not capture a high percentage of information, since many people don’t report for many reasons.
This system has taken years to devise, and is important because it could shorten the time it takes to detect drug safety issues and bring it don from years to months. This is good news, not only for Medicare recipients, but for all of us.
Many Medicare recipients have found themselves in situations where their physician feels they need a particular procedure but Medicare won’t approve it. Most people don’t know what to do when they find themselves in this situation.
The Medicare Rights Center, which is a national nonprofit organization, says that the best thing to do in this situation is to appeal the decision. Medicare is supposed to approve any medically necessary procedures, however, quite often it comes down to whether Medicare agrees with the doctor’s idea of what is medically necessary.
According to the Medicare Rights Center, it is often easy to win appeals for a number of reasons. One thing that happens quite a lot is that the denial is based on an accidental coding error, which means that someone put the wrong number or letter into a computer, making the computer think that you are requesting something different than you actually are and you end up being denied.
The Medicare Rights Center also says that many people don’t realize that they can appeal, or they think that the appeal process is too difficult. In actuality, the process is not that difficult and everyone has the right to appeal.
Some things that an individual should do to have a successful appeal as suggested by the Medicare Right Center are:
• Sign the back of the Medicare Summary Notice (MSN) and write on the front of it “Please Review”- send it back to the correct address by certified mail or with delivery confirmation;
• Include a letter with the MSN asking for the review and explaining why it should have been covered;
• Have the doctor include a letter explaining why the suggested procedure should be medically necessary and approved;
• Save photocopies of all written and oral communication, including notes, names and dates of ;hone calls;
• Make sure to do all of these things well within the 120 days allowed, or it will be too late to appeal;
• If you are in a private plan such as an HMO or PPO remember that you only have 60 days to appeal and some of the steps may be different.
It can be frustrating to get a denial, however, hopefully this information will help you if you ever find yourself in this situation. Hopefully, this will not happen, but if it does, this information should help you get the care you need.
Autism is a disability that affects hundreds of thousands of adults and children throughout the United States. It is a complicated disability and cannot be treated with a “one size fits all” formula.
Most states have services for children with autism through the school systems, and these services are available through twenty one years of age. At that point, most states have services available for adults.
Pennsylvania is a state that has been different. Though it has covered children with autism through age twenty one, Pennsylvania has been lacking in services for adults with autism. As a result, Pennsylvania has been granted the ability to use a portion of their federal Medicaid to fund services for adults with autism. $20 million will be made available annually to provide community and home services to benefit adults with autism. Some services will include respite care for families who are caregivers, as well as crisis intervention.
Individuals will be qualified for the program and benefits based on their income and the extent of their disability, giving them access to a variety of services. Pennsylvania Governor Ed Rendell stated “Prior to the establishment of this waiver program, there was nothing designed for people with autism once they reached the age of 21,.” This will also help more people with autism live in the community instead of in an institution.
According to Daniel Torisky, President of the Autism Society of Pittsburgh and secretary of the Autism Society’s state chapter, “The whole idea is to give them a jump start. It puts tem in line for significant and speedy improvement and accommodation to the complexities of our society.”
For those of us who know or have dealt with an individual who has autism and/or their family, this is a wonderful step forward in dealing with a disability that affects many people who can be helped to live a fuller life.
A regulation that was proposed and backed by President Bush to cut $5 billion in Medicaid funds for public hospitals over the ext five years was blocked by a federal judge Friday. This gives some Bay Area public hospitals a break and will let them breathe a sigh of relief for the time being.
Without this ruling, the funds would have started to be reduced starting Sunday, the day before Memorial Day. Temporarily, at least, the funds are still available, but this is only a temporary fix.
If the regulation eventually takes effect over 22 public hospitals will lose a total of approximately $600 million annually for the next six years. The California Association of Public Hospitals and Health systems located in Oakland, CA, is fighting hard to extend the moratorium on the cuts.
Alameda County Medical Center in the town of Alameda, a suburb of Oakland, serves a high number of patients and would lose about 20% of its total income and operating budget if the moratorium is not extended. This amounts to almost $100 million annually.
Other hospitals stand to lose millions as well. Santa Clara Valley Medical Center would lose nearly $38 million annually, San Mateo Medical Center, $11 million annually, Contra Costa Regional Medical Center, $9 million annually, and San Francisco General Hospital $29 million. This is just five hospitals that take care of a great number of individuals that have no other place to go for medical care.
In addition, University of California hospitals would lose $116 million annually.
The reason that the court blocked the regulation is that the court feels that the Bush Administration acted improperly in conjunction with CMS in trying to eliminate coverage that is the lifeline to many low-income individuals and families who depend on this coverage and assistance.
At this point, Congress, CMS, several governors and Mike Leavitt, head of department of Health and Human Services, have agreed to work together to try to solve some of the problems that have led to this point. Hopefully they will find a way to keep enough money available to these public hospitals that are in many cases the only lifeline low income individuals have.
The idea of health fairs is not new. There are heath fairs in cities across the U.S. that provide everything from information about gentle dentistry to on the spot blood pressure and bone density tests, and everything in between.
The middle Alabama Area Agency on Aging (M4A) is sponsoring a health fair for seniors this Friday. This will be the first ever, and it will be entitled “A Walk in the Park” because it will be held in the local park. The event will honor Older Adults Month.
Part of the purpose of the event is to raise awareness about the M4A organization, its purpose, its services and how/who it can help. The event will have several types of screening available for seniors including blood pressure checks, blood sugar testing, and cholesterol checks.
Various health care organizations will be available to answer questions, including home health care organizations. There will also be information available about M4A including information they provide and assist seniors with, such as their nutrition program called Homebound Meals (similar to Meals on Wheels), assistance with prescriptions called Senior RX; and assistance with the Senior State Health Insurance Assistance Program (SHIP). SHIP helps with Medicaid, Medicare, Medicare Supplements and SSI, health insurance and long term care.
M4A has an ombudsman who checks into complaints and works to help solve problems. They have a great many friends and contacts in the community, so if there is a problem they can’t solve or a question they can’t answer, chances are they can connect you with someone who can answer those questions and walk you through, working with you to fix the problem if at all possible.
There have been more and more programs such as M4A in communities throughout the country. To find out if there will be any presentations or a senior health fair in your community, contact your local senior centers, chamber of commerce and your doctor or local hospital. The information at these health fairs is usually free and you can surely benefit from the information you will receive.
I recently ran across an article about what to do to prepare for a natural disaster. Since my mother used to work on disasters, such as hurricanes, floods and earthquakes, we were painfully aware of keeping water, blankets and a few other things in the car and a full emergency kit including canned goods, water, flashlights, battery operated radios and more in the house.
One of the things that the article said – and, yes, my mother says and does – is to have a medical emergency kit available at all times. We are not talking about a first aid kit. That goes with all the stuff in the car and in the house in case of a disaster or other kind of emergency, including medical.
The emergency medical kits we are talking about is a container or file that has insurance coverage information including your health insurance company policy number, Medicaid or Medicare policy numbers, a list of your medicine with prescription numbers and dosages, your doctors phone number, a copy of your medical history from your doctor (you can usually get a copy for free), and names and contact information for family or friends and your doctor. Just in case, you might want a change of clothes in an overnight bag, as well.
We all have a tendency to think in terms of other people having the emergencies and if we think of ourselves, we think it probably won’t happen. Even if we have diabetes or high blood pressure, or other conditions which could lead to serious complications, we don’t usually have things prepared in advance. Why is that? For one reason, who wants to think of having an attack of some sort and having to go into the hospital? None of us.
It is important, though, and could be life-saving, to have a kit, if not, your paperwork as discussed above. Often in a rush into the hospital, we are disoriented, even if we are not in the middle of something as serious as a heart attack, we are, after all, in the hospital and usually worried, frightened, stressed or all three.
So, help yourself and help the friends or family that will be there to take you to the hospital, as well as the doctors and nurses who will be treating you and trying to help you. If you haven’t prepared yet, take the time to do it right away. It could save your life.
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