PurposeCare’s Post

CMS is forcing some people to fully align their Medicaid/Medicare plans and encouraging other dually eligible people to align their plans.This is beyond frustrating to me because CMS does not understand why people choose to not align their Medicaid and Medicare plans. There are several good reasons not to do align the plans including network issues and access to doctors. I have dually eligible clients who select PPO plans to keep doctors who do not accept Medicaid. I have dually eligible clients who do not take a MAPD because they need access to the Mayo clinic or Phoenix Children's Hospital. People who are dually eligible deserve the same choices as those who are not and should not be forced to align their plans.

Wondering what is in the recent eligibility and enrollment final rule from the Centers for Medicare & Medicaid Services? Read through our latest explainer from Tricia Brooks and Allexa Gardner ⬇ https://lnkd.in/ef3tARt4

🛑 Navigating the Maze: The Struggle for Medicare & Medicaid Beneficiaries to Access Essential Services 🛑 Saleema Render-Hornsby, a Bronx resident with spina bifida, waited 18 months for approval to get a new wheelchair. Despite being "dually eligible" for both Medicare and Medicaid, she faced a bureaucratic nightmare that left her without the mobility aid she desperately needed. 🔹 The Dually Eligible: About 12 million Americans are eligible for both Medicare and Medicaid. These individuals often have to navigate complex systems to get the care they need, leading to delays and denials. 🔹 The Red Tape: Saleema's case is a glaring example of how disjointed federal programs can make life harder for the dually eligible. The process involved multiple rounds of insurance denials and a year-long wait. 🔹 The Cost: Medicare and Medicaid spent nearly $450 billion in 2019 on dually eligible patients. Despite this, many still struggle to get the care they need. 🔹 Bipartisan Efforts: Sen. Bill Cassidy is leading a bipartisan effort to address these issues. A Senate bill aims to create a single insurance plan to manage both Medicaid and Medicare benefits, offering a more streamlined experience for beneficiaries. 🔹 The Human Toll: While waiting for her new wheelchair, Saleema's quality of life suffered. She had to think twice before going outside, affecting her social life and mental well-being. This story sheds light on the urgent need for systemic changes to better serve those who are dually eligible for Medicare and Medicaid. #HealthcareNews #Centerinsuranceandfinancialservices #CIFS #Medicare #Lifeinsurance #Healthinsurance #NMO #Aetna #Cigna #Humana #UHC #Devoted #Anthem #Wellcare #Joinus #Teamwork #Sales #Networking #Smallbusiness #Life #Healthylifestyle

The biggest difference between Medicare and Medicaid is who’s eligible. Medicare is based on age or disability. Medicaid is based on income: * You’re eligible for Medicare if you’re 65 or over or have a qualifying disability, such as end-stage renal disease or ALS. * You’re eligible for Medicaid If your income is below a certain level depending on your state. https://lnkd.in/gB2tKNPm

Why did they do it that way? Eligibility policy Ever wondered about Medicaid eligibility policy and why it works the way it does? NAMD can help. We're releasing our eligibility policy brief today as part of our ongoing series aimed at helping you better understand the reasons behind Medicaid policy across programs. In this brief you can find information on: -- Who must be covered by Medicaid and which coverage populations are determined by states -- How has Medicaid eligibility policy changed over time -- How does the eligibility process work step by step -- What operational factors impact eligibility policy Check out the full brief. https://lnkd.in/eNgF3MWt

MEDICARE ADVANTAGE DUAL-ELIGIBLE PLANS = MEDICARE FRAUD If you are 65 years or older, you qualify for healthcare insurance paid by the federal government. If you are poor, you qualify for social services paid by the State public health and State Medicaid programs. MEDICARE ADVANTAGE is MEDICARE FRAUD...Despite commercials on TV, falsely advertising Medicare Advantage is as good as the original Medicare. If you are under 65 yrs of age and have a child with a disability, are injured or sick and disabled, DO NOT SIGN-UP FOR MEDICARE ADVANTAGE. Increase rates of homicide and suicide in teens, rise in infant and maternal deaths, the spread of communicable diseases due to low vaccination rates, and premature disability and death, is DIRECTLY related to States that are deregulating Medicare. JUST SAY NO! #ama #cms #hcai #teamschein https://lnkd.in/gSr-AK3S

A Closer Look at Medicaid Expansion Efforts in Mississippi: This policy watch takes a look at recent Medicaid expansion activity, what expansion could mean in Mississippi, and what to watch. #medicaid #mdrp #financial

One question we hear often is, "Will #Medicaid pay for long-term care if I'm over the income limit?" If a person makes too much money to qualify for Medicaid, their state may offer options to reduce their income. Learn about each of these options—and where older adults can learn more about Medicaid and long-term care.👇 #MedicaidAnniversary https://lnkd.in/eD4M-Vqv

Qualifying for Medicaid LTC Benefits Could Get Tougher

Interesting study on Medicaid 12 & 24 month continuous enrollment. I've often felt that having members bounce between a Medicaid plan and a heavily subsidized ACA plan is too costly and challenging. Why not combine the 2? Gives Medicaid Plans the opportunity to have a consistent level of coverage and support and members either qualify for 100% or pay a small monthly amount based on income. https://lnkd.in/giDskChp