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Elder Law Attorney Agrees Managed Care May Help Quality of Care for California Seniors

Jun 20, 2013

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

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