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Aging Wisely November 2013 - Aging Wisely

Florida Medicaid: The Big Switch to Managed Care


Florida Medicaid advocacy

Medicaid reform legislation that was proposed in Florida in 2011 was designed to move management of Medicaid benefits to private, for-profit managed care companies. In the time since, there have been many meetings and debates, various changes, pilot programs and challenges to overcome in getting this concept implemented. However, the time is now here…and Florida Medicaid recipients will soon be receiving letters asking them to enroll in a particular plan (if they have not already). The state is rolling these changes out on different dates in the various counties. The roll out date for Pinellas, Pasco and Hillsborough counties is February 1, 2014.

What does this mean for Florida seniors?

If you are receiving Medicaid benefits or you have applied, this change affects you…and means you will have some decisions to make. If you care for an aging parent in Florida and/or serve as a decision maker (for example as guardian, P.O.A., healthcare surrogate) for a Florida elder or other person receiving Medicaid benefits , you should understand these changes so that you can assist and understand what choices need to be made. Essentially, all Medicaid beneficiaries will now be receiving benefits through a managed care company. So, they will have to choose which plan they wish to enroll in to manage their benefits. If a senior does not make a choice, Florida will choose a plan for that person. Enrollment is mandatory. The plan will oversee your benefits and care plan for determining how much/which benefits and services you receive. Once enrolled in a plan, a representative will meet with you and develop a care plan (you are entitled to have an advocate with you at this meeting and to have input in developing your care plan). If you have problems with your plan or the care being provided, there are specific processes for complaints and changes (the consumer guide below provides information on this; it is important to note that you have limited time frames for making changes and filing complaints).

What do I need to do?

You will have some decisions to make and it is very important to clearly understand these decisions and how they may affect your care. There have also been numerous program glitches that could cause issues for you. If you work with an Aging Wisely care manager currently, your care manager can help you through this process and provide resources to help at various stages. Our team has been studying the changes and getting training from some of the top experts, so we can be best prepared to help you. As always, we also work collaboratively with expert providers so we can refer you for help in specific areas.

Consumers can get some excellent information on these Florida Medicaid changes on the website Foundation for LTC Solutions. This group of Florida elder advocates has created resources like a decision tree and guide for the enrollment decisions. If you want to understand more about the program and decisions involved (as well as some of the pitfalls and important tips), you can download their Florida Medicaid Managed Care Consumer Guide. The guide is divided up in to sections based on your situation (answer a couple simple questions to be guided in to the correct section), so that while there is a lot of information you should only need to review the section that is applicable to your (or your loved one’s) situation.

Because Medicaid benefits will now be managed by the specific plan in which you enroll, the decisions can have a big impact on the care you receive. For example, if you are currently receiving home health benefits or care at assisted living, you may have to switch providers or move if your new plan is not contracted with these providers. We want to draw your attention to the importance of this major change, while not panicking you. Advocates have worked hard to spot the difficulties with the process and fight for protections. There are some safeguards built in and options if you encounter problems. Having a good care team is essential for each elder… you need strong advocates and resources to help (whether dealing with issues related to Medicaid managed care or just eldercare in general).

If you are working with Aging Wisely, your care manager will be reaching out to you about these changes as they apply to you and offering assistance. The resources above offer great insight for Medicaid recipients and their loved ones/decision makers to get an overview and answers to key questions.

If we can help with any questions or resources about Florida Medicaid, Medicare or other patient advocacy issues, please contact us at 727-447-5845.

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Can Patient Advocacy Help Me Get Well?


role of patient advocate

Friends and family have been advocating for loved ones when ill for many years, but the concept of professional patient advocacy is relatively new. To understand more about what a patient advocate is and does, check out our article “What is a Patient Advocate?“. The question we’re addressing today is if a professional patient advocate can actually contribute to the treatment and healing process. After hearing from several Aging Wisely clients and families, ” you saved my life” and “without you, Mom would not have made it through this health crisis”, we thought we would explore the role of patient advocates in outcomes of treatment.

The role of a professional patient advocate often begins when someone gets a diagnosis or is going through the process of exploring treatment and is faced with a long road ahead. Typically a patient and family are looking for support and assistance with certain issues that have arisen. Many times the advocacy role starts with helping the patient find the most appropriate treatment options.

Because care management is holistic in nature, this starts with understanding the client’s situation beyond the diagnosis. What are the goals and desires of the client? What other health issues and frailty exist? What type of support does the person have? What issues will there be in practical, day-to-day life (managing medications, nutrition, getting around the home safely, getting to follow up appointments)? What social, spiritual and emotional issues is the person facing? How does the family feel? What family is involved and what conflicts might exist? On a more practical level, the care manager also looks at issues like costs, insurance and paperwork. Does the person have insurance to cover treatment at the desired providers? What other benefits or programs can help? Can the person afford medications and follow up treatment? Does the client have legal paperwork in place? The care manager then goes in to advocacy mode to find appropriate solutions to any issues that exist…thus clearing the path for treatment and healing.

Another major aspect of patient advocacy is helping to ensure patients and families have the necessary information. While informed consent is considered a basic part of today’s ethical medical practice, the level of “informed” varies. Patients may have different levels of “health literacy” and may feel too ill to advocate for themselves as they once would have done. Some practitioners may speak in medical terminology and may also be focused on outcome when a patient may have concerns about process and quality of life that are not addressed.

During the treatment process, the care manager continues to follow up with all of the areas listed above, but also helps to ensure continuity of care. This is particularly essential during treatment, as the advocate coordinates providers and sets up follow up so the patient and family can focus on getting well. During treatment for any diagnosis, most patients are also dealing with other chronic illnesses or diagnoses which need to be monitored. The person may see changes to overall health and other treatments may be affected while dealing with a new illness. Additionally, practical matters are important in the healing process. A patient may be receiving chemo at a treatment center or may have surgery and then some rehabilitation…but what happens at home after these treatments can really impact long-term health and healing. Is the person eating properly (and following any special diet required)? Is the person safe or at risk for falls or accidents? Does the person need help changing dressings or doing other follow up care? The list of what needs to be assessed (and addressed) goes on and on. A professional patient advocate has the experience to anticipate these issues and find solutions.

So, what do you think? Does the patient advocate play a vital role in healing? Is treatment about more than having the best specialist in the world and the latest protocol? There doesn’t appear to be any clinical data out there on the subject yet, though many patients and families have examples to share (we’ll be sharing more of these in the future, so check back!). We’d love to hear what you think! Join us on any of our social media outlets to continue the conversation, or give us a call at 727-447-5845 to find out how our Florida Patient Advocates can help!


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A Tribute to our Elder Veterans (Plus Veterans Benefits Information)


Check out this history of Veterans Day to learn more about the holiday:

We wish to extend a tribute and huge thank you to all our veterans! At Aging Wisely, we are fortunate to work with many elder Vets and learn about some of their heroic stories. These veterans typically do not think of themselves ar heroes, but feel their actions were simply the necessary thing to do. Most times, we only learn about these veterans’ stories through their family members or after drawing them out after many hours spent together.

As Tom Brokaw stated, “The World War II generation did what was expected of them. But they never talked about it. It was part of the Code. There’s no more telling metaphor than a guy in a football game who does what’s expected of him-makes an open-field tackle-then gets up and dances around. When Jerry Kramer threw the block that won the Ice Bowl in ’67, he just got up and walked off the field.”

In addition to these World War II vets, we are now working with veterans of the Korean conflict, Vietnam era and the more recent Gulf wars. Florida is one of the states with the largest number of veterans, approximately 1.7 million. There are more than 9 million veterans in the U.S. over age 65. Many of these veterans now need assistance due to aging and disease, plus the number of service-connected disabilities amongst veterans has increased as well as expenditures for healthcare and disability compensation.

The Veteran’s Administration (VA) offers help for veterans in various forms, from disability compensation to employment programs and healthcare. The eligibility rules and process can be overwhelming for veterans to navigate and many times older veterans who have not used services are not aware of some of the help available. For a quick overview of some of these benefits, especially as they apply to elderly veterans, check out our article on senior care for veterans.

When we do a geriatric assessment, we review demographic and background information which helps us identify potential benefits and programs for which our clients may be eligible, such as veterans benefits. We work with our clients/families to make recommendations and provide guidance through an array of assistance.

One great resource for veterans in Florida are the counties’ Veterans Services offices. For example, you can find the Pinellas County Veterans Service Office website here for more information. Their services are free of charge and they assist with understanding programs, presenting and filing claims and appealing denied claims. Their site offers an overview of programs available and the information for making an appointment at one of the local offices. We highly recommend to all of our clients that they use the services of the county veterans’ service office to navigate the benefits’ claims process.

Solutions When You Need Them….for Florida Veterans and their families

Know an older Florida veteran needing help? Give our Senior Care Consultant a call at 727-447-5845. We can help with veterans’ home care, navigating veterans benefits, identifying various programs and services to help and manage healthcare needs…plus much more.

Our thanks to all our veterans for your service to this country!

“We owe our World War II veterans–and all our veterans–a debt we can never fully repay.”–Doc Hastings

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Medicare Advice and Analysis: The 2014 Medicare Costs


The 2014 Medicare numbers have been released. This includes the new costs you can expect for Medicare’s premiums, copays and deductibles. The numbers have not changed drastically for 2014. Some costs have stayed the same, some had small increases and the Part A premium (for those who pay it) will actually decrease. Here’s a quick summary of the how the Medicare costs for 2013 and 2014 compare:

Part A (hospital insurance) premium

Most people do not pay a premium. If you do not have sufficient work quarters, you will pay up to $426/month to buy in to Medicare A (down from $441 this year).

Part A deductibles/co-insurance for inpatient hospital stays

$1216 deductible for each benefit period (up from $1,184 in 2013)

Co-insurance of $0 days 1-60 in hospital

Co-insurance of $304/day for days 61-90 (up from $296 in 2013)

Co-insurance of $608/day for each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime, beyond reserves you pay all costs) (up from $592 in 2013)

Part A skilled nursing facility (SNF) co-pays

$0 for days 1-20

$152 for days 21-100 (up from $148 in 2013)

*Skilled nursing facility coverage is based on meeting criteria (medical necessity for skilled inpatient rehabilitation/care and services are reasonable and necessary for your condition/prognosis). You do not automatically get a full 100 days and for many conditions, less time is very likely. The SNF coverage is also dependent upon a qualifying 3-day hospital stay for the related condition. To learn more about this and when a hospital stay qualifies (i.e. is “inpatient” versus “observation”) read our article Important Information on Hospital Coverage for Medicare Recipients.

Part B (medical insurance) premium

$104.90/month for beneficiaries in the standard income category (making less than $85,000 or less as an individual) (unchanged from 2013)

Higher income individuals pay higher amounts, up to $335.70

Part B deductible

$147/year (unchanged from 2013)

Part D (prescription drugs)

Your premium is based on the plan you choose. You will also pay an extra adjustment each month if your income is greater than $85,000/year (for an individual, $170,000 for joint filers).

For an overview of all the costs plus a more detailed summary of Medicare’s parts, enrollment periods and more, check out Aging Wisely’s 2014 Medicare fact sheet. If you would like copies of this resource for your clients or community group, please contact Aging Wisely at 727-447-5845.

Aging Wisely’s patient advocates provide advice on Florida Medicare and Medicaid, a complete analysis of Medicare options for each individual and help with any insurance coverage issues. Until December 7th, Medicare recipients have the opportunity to switch plans for 2014 (Medicare D plans or switch to/from a Medicare Advantage plan). This is a critical time to evaluate if you are in the right plan, to potentially save costs for 2014. Give our Senior Care Consultant, Sue Talbott, a call at 727-447-5845 to discuss how we can help with Florida Medicare and other insurance and benefits issues! Read the rest of this entry »

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Our goal is to enable every individual we work with to live the most fulfilling life possible, with utmost dignity, focusing on their physical, mental, spiritual, family and financial wellbeing.