AARP applauds the unanimous passage in the U.S. Senate of the bipartisan Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (S. 1028).
The legislation, introduced by Senators Susan Collins (R-ME) and Tammy Baldwin (D-WI), calls for the development of a strategy to support the nation’s 40 million family caregivers. It would bring together stakeholders from the private and public sectors to recommend actions that communities, providers, government, and others are taking and may take to help make the big responsibilities of caregiving a little bit easier.
It would bring together stakeholders from the private and public sectors to recommend actions that communities, providers, government, and others are taking and may take to help make the big responsibilities of caregiving a little bit easier.
Every day, millions of Americans are caring for parents, spouses, children and adults with disabilities and other loved ones so they can live independently in their homes and communities for as long as possible. They take on a range of tasks including managing medications, helping with bathing and dressing, preparing and feeding meals, arranging transportation, and handling financial and legal matters. The unpaid care family caregivers provide helps delay or prevent costly nursing home care, which is often paid for by Medicaid.
“Family caregivers are the backbone of our care system in America. We need to make it easier for them to coordinate care for their loved ones, get information and resources and take a break so they can rest and recharge,” said AARP Chief Advocacy & Engagement Officer Nancy A. LeaMond. “Thanks to the efforts of long-time champions of the bill Senators Susan Collins and Tammy Baldwin, we are one step closer to helping address the challenges family caregivers face.” AARP is working to bolster bipartisan support for the RAISE Family Caregivers Act in the U.S. House of Representatives.
The bill (H.R. 3759) was introduced by Representatives Gregg Harper (R-MS) and Kathy Castor (D-FL), along with original cosponsors Representatives Michelle Lujan Grisham (D-NM) and Elise Stefanik (R-NY). The RAISE Family Caregivers Act has the support of about 60 national organizations.
For more information and to track this bill visit Congress.gov.
In May 2016, Anna Shobe-Wallace, program manager for Louisville Metro Community Services said, “Each year, more than 500 young people between the ages of 18-21 age out of Kentucky’s foster care system.” Many youth ‘aging out’ are disconnected from larger society and face barriers to success such as: low socioeconomic status, low educational achievement, unplanned pregnancy, racial segregation, and mental and physical challenges.
A recent study assessed the plight of disconnected youth who are teenagers and young adults between the ages of 16 and 24, and these youths are neither employed, enrolled in or attending school. The study focused on disconnected youth in the following categories: by state, county, congressional district, gender, and by race and ethnicity. Currently, there is approximately 5,527,000 disconnected youth in the United States or 13.8% of young adults.
Kentucky ranks 36th in youth disconnection rates with 15.2% of youth in this group for a total of 81,850.
Cincinnati, OH–KY–IN ranks 44th in youth disconnection among the most densely inhabited areas. The percentage of disconnected youth in this area is 12.8% or 38,312 total. The racial breakdown for this group is 20.6% Black and 11.8% White.
Louisville/Jefferson County, KY–IN ranks 56th in youth disconnection. The percentage of disconnected youth in this area is 14.0% with a total of 21,750 disconnected youth. The racial breakdown for this group is 18.5% Black and 13.3% White. This Kentucky county has the lowest percentage of disconnected youth.
Kentucky counties with the largest percentage of disconnected youth are as follows: Martin County, Kentucky ranks 2,020th with 47.8% disconnected youth; Union County, Kentucky ranks 2012 with 43.7% disconnected youth; Bracken County, Kentucky ranks 1,998th with 41.4% disconnected youth; Lee County, Kentucky ranks 1,994th with 40.9% disconnected youth; McCreary County, Kentucky ranks 1,992nd with 40.4% disconnected youth; Morgan County, Kentucky ranks 1,985th with 38.7% disconnected youth; and Wolfe County, Kentucky ranks 1,972nd with 37.5% disconnected youth
Researchers from this study concluded that larger urban communities had increased numbers of disconnected youth due to the following indicators: a historical pattern of disconnection, decreased neighborhood well-being rates, low SES, increased unemployment, a lack of academic achievement, and racism.
These alarming statistics clearly indicated systemic issues that impact disconnected youth. Experts from this study proposed that, “Disconnection is not a spontaneously occurring phenomenon; it is an outcome year in the making.” With this thought in mind, the study recommended these steps moving forward:
An estimated $26.8 billion dollars was involved with supporting the nation’s 5.5 million disconnected youth— comprising Supplemental Security Income payments, Medicaid, public assistance, incarceration, in 2013. Proposing more beneficial ways to invest in this population would be advantageous to society as a whole.
Designing preventive measures to address disconnection by sustaining at-risk parents and investing in quality preschool programs. It is usually more cost effective and compassionate to implement prevention strategies than crisis responses.
Re-joining youth and young adults who are secluded from higher education and the job market is more expensive than pre-emptive methods that address disconnection at the outset. However, these young people need another opportunity—considering many came from challenging backgrounds.
At the community level, an evident positive correlation was seen between adult employment status and youth’s relationship to education and employment. The amount of education adults had greatly projected the likelihood of young people ages 16 to 24 years old to attend school.
Amy Swann, author of “Failure to Launch”, notes that for 2013, the study data indicates that the Louisville Metropolitan Area (which consists of bordering counties) has 14.0 percent of youth ages 16-24 disengaged from employment and education. The study’s emphasis on cities resulted in reporting by Louisville news outlets at the Courier-Journal and WFPL. Media exposure of the status of disconnected youth in Kentuckiana has led to remarkable new efforts that focus on this population.
In light of this compelling evidence: social workers, legislators, and other helping professionals in the state of Kentucky have amassed their efforts to cultivate community partnerships and programs to support disconnected youth on their journey into emerging adulthood.
According to their website, here is a description of each program, and how it addresses the needs of disconnected youth and youth ‘aging out’.
Family Scholar House plans to open its fifth Louisville campus at the Riverport Landings development in southwest Jefferson County. The project goal is to equip families and youth to excel in education and to obtain independence. The new facility is expected to be ready by 2017 and will accommodate low-income families, single-parent families, and young adults formerly in foster care.
Fostering Success is a summer employment program developed by Gov. Matt Bevin that began June 1, 2016. The program provides job training via the Kentucky Department for Community Based Services for youth ages 18 to 23 years old. The program will run for 10 weeks and culminate with meetings with college and career counselors to prepare participants for future education and employment goals. Approximately 100 youth will be employed full-time at a rate of $10.00 dollars per hour. Fostering Success is one of the seminal programs in the state to target youth aging out.
Project LIFE serves 60 kids across Kentucky, including 25 in Louisville and offers an empowering environment to prepare them for success. Youth are given a housing voucher, along with social supports to improve access to education, employment, and income management skills.
Coalition Supporting Young Adults (CYSA) is an initiative created to address the barriers faced by Louisville’s disconnected young people. The mission is to develop: a standard agenda that meets the needs of Louisville’s vulnerable youth and young adults; common measurement tools that define collective goals and strategies; mutually supportive activities that create new partnerships and execute thoughtful programs; effective communication that creates a viable structure; foundational support that stimulates growth, responsibility, and dependability.
Transition Age Youth Launching Realized Dreams (TAYLRD) is an effort to create a unique program for young people born out of the federal government’s proposal called “Now is the Time” Healthy Transitions Grant Program. The Department of Behavioral Health (DBH) in Kentucky requested and received funding and Seven Counties was chosen as a venue to open drop-in centers where young people can foster relationships and access support /services to achieve their future goals. Youth Peer Support Specialists (YPSS) and Youth Coordinators work together with clients to define what concerns are most important, and then appropriate services/supports are brought into the drop-in centers. Some of the supports/services offered include: case management, life skills development, employment services, academic support, legal support, and therapy.
True Up founded by foster care alum Frank Harshaw, is a nurturing group of foster care alumni who have overcome obstacles to employment, pursuing education, gaining independence and solidifying healthy relationships. They have chosen to pay it forward through mentorship. True Up empowers foster youth through academic and hands-on learning in the following areas: Mobility & Transportation, Career Mapping, Financial Management, Relationship Building Skills, and Educational Achievement.
These are just a few of the innovative programs and resources available in the state of Kentucky. As helping professionals and the broader community create data driven programs for disconnected youth and youth aging out, expected outcomes will be much more positive in the near future.
As politicians struggle to solve the nation’s healthcare problems, a new study finds a way to improve health and lower costs among Medicaid and uninsured patients.
Researchers at the Perelman School of Medicine at the University of Pennsylvania showed that patients who received support from community health workers (CHWs) – trained local residents who provide tailored support to high-risk patients– had 30 percent fewer hospital admissions in one year compared to those who did not receive CHW support. The results, published today in the
The results, published today in the AmericanJournal of Public Health, also showed reductions in cigarette smoking, obesity, diabetes severity, and mental illness. This is the second clinical trial to demonstrate improved health and hospital reductions with the IMPaCT (Individualized Management for Patient-Centered Targets) CHW program. The annual return on investment for the program was $2 for every dollar invested.
The IMPaCT program pairs CHWs with chronically-ill patients from low-income neighborhoods. CHWs meet with patients regularly to encourage healthier behaviors, and otherwise provide support for the patients’ own health goals.
Emblematic of the kind of patients who benefit from CHW interventions, one young woman was unemployed, struggling with low self-esteem, and had tried for years to lose weight before she met CHW, Saphia Allen. Saphia helped the patient find affordable interview clothes and went with her to job fairs. Saphia also connected the patient to other neighborhood women and twice a week attended get-togethers with the group where the women would go for walks and share their real-life challenges. With her newfound community, the patient lost 10 pounds and successfully gained employment.
In the new study, the Penn team focused on 302 mostly Medicaid-insured individuals who had multiple chronic diseases. Half received regular support from IMPaCT-trained community health workers. After six months, the patients who had received support from CHWs showed better outcomes on several measures, including lower blood sugar levels, lower body mass index and reduced cigarette smoking. Patients in the intervention group also showed greater improvements in mental health, and were 20 percent more likely to rate their primary care as comprehensive and supportive of their self-management of disease.
“This is the second clinical trial that shows improved health and lower hospital admissions for the IMPaCT community health worker program,” says senior author Shreya Kangovi, MD, an assistant professor of Medicine at the Perelman School of Medicine and executive director of the Penn Center for Community Health Workers.
In 2014, Kangovi and colleagues found evidence that the IMPaCT model improved mental health and lowered hospital readmission among patients recently discharged from the hospital. “We now have evidence for state Medicaid programs or health systems looking for proven strategies to improve health and lower hospital use.”
Based on the reduction in hospitalizations seen in the studies, the University of Pennsylvania Health System estimates a return on investment of $2 for every $1 spent on IMPaCT.
“As a nation, we have spent years arguing about healthcare. We need to focus on getting people healthy while reducing spending,” says Ralph Muller, CEO of the University of Pennsylvania Health System. “This program accomplishes both of these goals and shows us a way forward.”
Over the last twelve months, my colleagues and I have spoken at length with close to one hundred Native American seniors across the state of New Mexico about their health care and health insurance. Since November 2016, these seniors have expressed profound apprehension about the future of health care and insurance coverage under President Donald Trump’s administration, both for themselves and for their friends and relatives. As one elderly woman put it, “I have care, but is [Trump] going to take that away from us?”
Most Americans assume that regardless of any changes to the Affordable Care Act (Obamacare), the healthcare needs of seniors will be covered by Medicare, which serves individuals who are 65 years of age or older and who have paid into the Medicare system via payroll taxes. In fact, even if the current Medicare system remains in place, Obamacare repeal will have profoundly harmful effects on older people, especially those under 65 who have low-incomes, live in rural areas, or are in need of long term care or help to stay in their homes. In fact, seniors are among the most likely people to be hurt by plans to replace Obamacare.
How Obamacare Has Benefited Seniors
Seniors age 55 and over make up an increasing part of the U.S. population and their healthcare needs are extensive and complex. The National Council on Aging estimates that 92% of older adults suffer from a chronic illness, such as diabetes or heart disease. Seniors also have high rates of cognitive health problems, including Alzheimer’s and dementia. A growing number of older adults experience mental health and substance use problems. Even as they face such health problems, many seniors have limited incomes and struggle with the costs of housing, food, and health care.
Although Obamacare is often seen as an effort to increase insurance coverage among younger and healthier people, it has also provided numerous benefits to seniors. These benefits are not only endangered by current replacement plans, they appear to be specific targets of Republican proposals. For instance, Obamacare’s prohibition of annual and lifetime limits on insurance coverage – as well as its limits on the ways insurance companies can raise prices for people with preexisting conditions – have made it possible for older adults with a variety of health problems to get affordable insurance and care.
Seniors have also benefitted from Obamacare’s expansion of Medicaid, which extended eligibility to adults at or below 138% of the federal poverty level. According to the Kaiser Family Foundation, more than six million seniors have received new coverage from Medicaid, including older adults under 65, Medicare beneficiaries with low incomes, and seniors who do not qualify for Medicare because they did not pay enough into that program during their working years. This last group includes elderly adults who are homeless or disabled, as well as those who were previously farmers, ranchers, and homemakers.
What is more, Medicaid covers long-term and in-home care services not covered by Medicare. These services allow seniors with serious medical concerns to receive high-quality care, either in a nursing facility or their own homes. In fact, the Kaiser Family Foundation estimates that 6 in 10 nursing home residents are covered by Medicaid.
In addition to extending these critical benefits to seniors, the Medicaid expansion has generated new revenues for providers of healthcare services that many elders need – including mental health and substance addiction services, transportation services, and help to purchase medical equipment needed by adults who wish to remain at home throughout their elder years. These improvements are especially important for seniors in rural areas, where service providers are sparse and patients must travel long distances to find care. As our research in the rural state of New Mexico reveals, healthcare providers report that Obamacare has helped them address the complex health issues faced by aging patients.
Obamacare has also significantly improved Medicare – by ensuring access to no-cost preventive care and screenings and expanding prescription drug coverage. Crucially, Obamacare addresses the previous Medicare gap in prescription drug coverage, where insurance did not pay for drug costs after an individual reached a certain level of costs. Obamacare discounts drug prices for seniors who fall into that coverage gap and aims to close the gap by 2020. Repeal of the law would significantly increase the cost of prescription drugs, disproportionately affecting seniors.
How Republican Plans Will Hurt Seniors Overall
Not only will repealing or reducing core benefits of Obamacare disproportionately hurt seniors, Republican proposals include provisions that will specifically penalize seniors, such as those that would let insurance companies charge older people up to five times more for insurance than younger adults. Families USA estimates that this could put marketplace insurance financially out of reach for 3.3 million people over the age of 55. Proposed caps on lifetime benefits and the elimination of regulations regarding the essential benefits that insurance plans must cover will put seniors at risk of “running out” of coverage as they age or being unable to afford insurance that will actually cover their medical needs.
Whether or not Obamacare is ultimately repealed, cuts to Medicaid – a core part of U.S. health insurance since 1965 — remain likely and will have especially harmful effects on the numerous seniors who rely on the program for long-term care, including the estimated one-third of American seniors who fall below 200% of the federal poverty line. In addition, reductions or caps to federal funding for state Medicaid programs will serve to deepen existing inequities in care for poor, older, and disabled people in the poorest and sickest states.
Better Care for Seniors Helps Everyone
Ultimately, while seniors have specific and complex needs, ensuring their health is important for everyone in all parts of the United States. When older people cannot get health insurance or adequate care, the burdens are often shifted to their adult children and grandchildren. Many seniors also care for their children and grandchildren, many of whom get help from Obamacare’s benefits for all low-income adults and children. Although Obamacare has very real limitations, the prospect of repeal is already plunging seniors into a state of fear and uncertainty. All Americans should join senior citizens in worrying about the drastic downsides for families and communities, especially in rural areas, if current Republican plans become law.
More than 700,000 elderly and disabled Americans receive health care in residential care communities, such as assisted living facilities. As the population ages, this number will grow.
A new study by RTI International found that low Medicaid payment rates for services in assisted living and similar settings discourage residential care providers from serving Medicaid beneficiaries, which limits their access to community-based residential care.
The study found that some residential care settings limit the number of Medicaid residents they serve or decrease operating expenses in ways that may also reduce quality of care.
“Medicaid payment rates only cover services in residential care settings; they do not cover room and board,” said Michael Lepore, Ph.D., senior health policy and health services researcher at RTI and lead author of the study. “One of the access barriers is the difficulty that Medicaid beneficiaries have paying for room and board in residential care settings because of their low incomes. This situation dissuades residential care providers from serving Medicaid beneficiaries.”
Residential care settings are community-based homes or facilities that offer room, board and care services, the most popular being assisted living. Compared to nursing homes, these settings often are less institutional and are often the preferred setting.
If Medicaid beneficiaries with long-term service and support needs cannot access residential care settings, then nursing homes may be their only option, ultimately costing taxpayers more money because Medicaid payment rates for nursing homes are higher.
The study, published in the Journal of Housing for the Elderly, found barriers that influence Medicaid beneficiaries’ access to state-licensed residential care include Medicaid reimbursement rates for services, the supply of Medicaid-certified residential care settings and beds, and policies that affect room and board costs for Medicaid beneficiaries.
Researchers examined Medicaid policies in all 50 states and the District of Columbia, interviewed subject-matter experts, and conducted four state case studies informed by reviews of state policies and stakeholder interviews.
“States need to ensure their Medicaid rates for residential care services are sufficient to maintain an adequate supply of these settings and beds available to Medicaid beneficiaries, while also safeguarding quality of care and taxpayer resources,” Lepore said. “Higher Medicaid rates may encourage more residential care settings to serve Medicaid beneficiaries, which may help reduce nursing home use by older adults and people with disabilities and potentially reduce Medicaid spending on long-term services and supports.”
The budget proposed by President Donald J. Trump threatens critical health, scientific research and education programs that contribute to the social safety net for millions of Americans, according to the American Psychological Association.
“This budget, if enacted, would jeopardize our nation’s educational, scientific and health enterprises and limit access to critically needed mental and behavioral health services,” said APA President Antonio E. Puente, PhD. “These cuts would disproportionately affect people living in poverty, people with serious mental illness and other disabilities, women, children, people living with HIV/AIDS, older adults, ethnic and racial minorities, immigrants, and members of the LGBTQ community.”
“While every administration must make difficult budget decisions, any attempts to balance the federal budget should increase, not decrease, the number of Americans who have access to high-quality education, health care and social support,” said APA CEO Arthur C. Evans Jr., PhD. “APA calls on Congress to reject this budget proposal and replace it with one that protects and increases access to services and care for all Americans.”
Among the cuts denounced by APA:
• $7.2 billion from the National Institutes of Health, approximately a 21 percent decrease from the FY 2017 level, which would result in 1,946 fewer grants. The National Science Foundation would receive a cut of approximately $820 million compared to FY 2017, a decrease of 11 percent.
• More than $600 billion in reductions over the next decade from the Medicaid program, which could eliminate Medicaid benefits for about 7.5 million people. The proposal also includes the option for states to choose between a per capita cap or a block grant beginning in FY 2020. Medicaid is the single largest payer for behavioral health services in the United States, accounting for over 25 percent of behavioral health spending.
• Elimination of the Graduate Psychology Education Program, the Behavioral Health Workforce Education and Training Program, and the Geriatric Workforce Enhancement Program, which together would reduce mental health workforce training by nearly $100 million.
• Almost $400 million from the Substance Abuse and Mental Health Services Administration, including a roughly 22 percent reduction from the Community Mental Health Services Block Grant.
• 14 percent ($9.2 billion) from the U.S. Department of Education, eliminating investments in educational equity and quality, including slashing other key programs that support gifted students, effective teaching and professional development.
• Elimination of the Public Service Loan Forgiveness program and programmatic changes that would prolong repayment periods for students with graduate school loans.
• 13.2 percent cut from the U.S. Department of Housing and Urban Development, including elimination of the Community Development Block Grant.
• $200 million reduction for the Special Supplemental Nutrition Program for Women, Infants and Children.
• Elimination of 75 employees from the Office of Justice Programs, including a cut of over 30 percent, reducing the office’s budget from $1.8 billion to $1.3 billion. The agency administers critical juvenile and criminal justice grants and houses the Bureau of Justice Statistics, Bureau of Justice Assistance and National Institute of Justice.
“A strong educational system is the foundation of a globally competitive workforce that fosters innovation, discovery and research,” Puente said. “As other countries continue to invest in education as part of their economic and workforce development strategies, the need for increased federal investment in American education has never been more important to our nation’s economic stability, national security and public health.”
“APA looks forward to working with Congress to ensure a more balanced approach to addressing our nation’s fiscal 2018 budget priorities, including making progress on increasing access to mental health care and addressing the opioid epidemic, investing in the scientific enterprise and expanding access to higher education for all Americans,” Evans added.
Almost everyone covered through Ohio’s Medicaid expansion would have no other viable insurance option should the Affordable Care Act be repealed, a new study has found.
Law and public health researchers from The Ohio State University determined that 95 percent of newly enrolled beneficiaries would be without a plausible pathway to coverage. The research appears online in the American Journal of Public Health.
Ohio is one of 31 states (and Washington D.C.) to expand Medicaid eligibility as part of the Affordable Care Act. The move, which came in January 2014, made eligible those adults with incomes below 138 percent of the federal poverty level. (In 2015, that was about $16,243 earned annually for an individual.)
Prior to the ACA, Ohio generally did not grant Medicaid eligibility to childless adults unless they were pregnant or disabled. Parents qualified for Medicaid only if their family income was below 90 percent of the federal poverty level. By October of last year, enrollment under expansion in Ohio had reached about 712,000 people.
Efforts to repeal or substantially restructure the ACA reforms are under way.
Seiber and Micah Berman, assistant professor of public health and law at Ohio State’s College of Public Health and Moritz College of Law, evaluated data from 42,876 households that participated in Ohio’s 2015 Medicaid Assessment Survey. The telephone survey includes a set of questions to identify coverage immediately before Medicaid enrollment.
The new Ohio State research was driven by this question: “If the ACA is fully or partially repealed, who would lose their coverage and what would happen to them?”
The researchers found that the vast majority would find themselves without insurance in the case of a full ACA repeal.
Though 17.7 percent of survey participants had private health insurance prior to Medicaid enrollment, most had lost their jobs (and their coverage) or were ineligible for employer-sponsored group health plans at the time of enrollment. The researchers found that 4.8 percent of the new Medicaid recipients were eligible for insurance through their jobs, leaving 95.2 percent of new enrollees with no feasible alternative.
Seiber and Berman also found that a rollback would predominantly affect older, low-income whites with less than a college education.
“The impact of insurance is about a lot more than health care,” Berman said. “For people newly enrolled in Medicaid, it means that should they have a major health-related event, they can still pay for food, have stable housing, get out of debt. These are all things that make a huge difference in quality of life.”
A recent Ohio Medicaid analysis, which was conducted with help from Seiber and Berman and mentioned in the new study, found that that the expansion increased access to medical care, reduced unmet medical needs, improved self-reported health status and alleviated financial distress – all results found in other states that have expanded access to government coverage.
The new study shows that the majority of adults newly enrolled in Medicaid did not drop private insurance in favor of the government coverage, Seiber said.
“These are very low-income adults, many of whom lost their jobs and have nothing to go back to,” he said.
Said Berman, “It counters this perception that people have health insurance but then go on Medicaid to save money. That’s just not what the data show.”
That did happen, to an extent, with expansion of Medicaid coverage for children. But that was a different scenario because children’s eligibility begins at much higher family income levels than those in place for new adult enrollees, Seiber said.
Seiber and Berman said they hope the study offers some scientific data that will be useful during discussions of ACA repeal or revision and what it could mean for Americans now covered by Medicaid.
“I don’t think everyone realizes that if you repeal the ACA, that at the same time eliminates the Medicaid expansion,” Seiber said.
One potential weakness of the study is that the researchers were not able to evaluate how many people on Medicaid had the option to move to private insurance – because they were newly employed, for instance – but did not go that route. That type of analysis was not possible with the state-gathered data, Seiber said.
“While it is possible that some portion of these enrollees have since been hired by an employer that offers (insurance), it is unlikely that this would meaningfully improve the insurance outlook for this population,” he and Berman wrote.
The researchers said it’s important to consider the demographics of those covered under Medicaid expansion, including the fact that many are older and already have chronic health conditions that will become more costly and problematic without regular care.
“It’s a really broad cross section, and tends to be older and whiter and more rural than many would expect,” Seiber said.
PENNSYLVANIA— Medicaid waivers that improve access to home and community-based services for children with autism also help their parents keep their jobs, according to research from Penn State College of Medicine and collaborators.
Previous research found that families of children with autism spectrum disorder experience more challenges obtaining child care and other services compared to families of children with other special needs. Medicaid waivers that target children with autism spectrum disorder help families obtain expensive services they may not have otherwise been able to afford.
Parents of children with autism are also encouraged to commit significant time to participating in their child’s treatment.
“When you’re spending all that time just trying to help your child, there’s less time for work,” said Douglas L. Leslie, professor of public health sciences and psychiatry, Penn State College of Medicine.
When these two factors are combined, the reality is that one parent often significantly reduces their work hours or stops working altogether, increasing financial stress on families that may already be struggling to pay for costly services.
Leslie’s team, along with collaborators at the Perelman School of Medicine, University of Pennsylvania and the RAND Corporation, set out to determine if Medicaid waivers affected parental employment in families of children with autism. The study appears today (Feb. 6) Health Affairs.
Historically, private health insurers have not covered services for children with autism, Leslie said, putting the onus on school systems. That help can come too late, because research shows that children with autism benefit from interventions that begin before school-age.
“There’s been a lot of policy work over the last decade or so to try and improve insurance coverage for kids with autism,” he said. “One of the main mechanisms they’ve tried to do this through is Medicaid waivers.”
Many states have introduced home and community-based services waivers that expand eligibility for Medicaid-reimbursed services and provide services that are not covered under the standard Medicaid benefit.
“We’ve done some research looking at the effects of these waivers on things like access to care and unmet needs, and we thought it would be useful to see whether they’ve had an impact on parent’s labor market decisions,” Leslie said.
Leslie and his collaborators used information from a nationally representative survey as well as Medicaid waiver data to determine how waivers impacted parental employment from 2005-2006 and 2009-2010.
They found that waivers were effective at allowing parents to remain in the work force. When cost limits and enrollment limits for waivers were raised—giving more families access to more services—the likelihood that a parent had to leave the workforce also decreased.
Characteristics of waivers, such as how much can be spent per child participating in the waiver and how many families can receive services under the waivers, differ from state to state. In the study, the characteristics of a state’s waiver program determined who was helped by that program.
Waiver programs that increased cost limits—making waivers more generous and putting more services into homes—helped the most in lower-income households.
Waiver programs that increased enrollment limits—allowing more families to receive benefits—made the biggest difference in higher-income households that would not otherwise have qualified for Medicaid services.
“Characteristics of the waivers matter,” Leslie said.
He noted that although waivers can help parents of children with autism stay afloat financially, keeping these parents in the workforce goes beyond monetary considerations.
“Caring for a child with autism is difficult,” Leslie said. “Having an outlet through a job can be very beneficial to the parent’s mental wellbeing. It gets them out into the community.”
Leslie hopes his findings will provide more information to policy makers who hold the purse strings for assistance programs such as home and community-based Medicaid waivers.
“The policy landscape with respect to autism services is very much in flux right now, especially with talk of healthcare reform potentially being reversed,” Leslie said. “I think we need as much information out there as we can get about the benefits of some of these programs so that policy makers can be informed about which policies work and how we can ensure that these vulnerable populations can remain protected as we continue to think about healthcare reform.”
Leslie is continuing to research how waivers affect families and children with autism. He is currently investigating whether waivers are effective at getting more children with autism into evidence-based care and if they reduce problematic outcomes, such as hospital admissions and emergency department visits.
Other researchers on this study were Khaled Iskandarani, research data analyst, Diana Velott, senior instructor and Edeanya Agbese, research project manager, Department of Public Health Sciences Penn State College of Medicine; Bradley D. Stein, RAND Corporation in Pittsburgh, Pennsylvania; Andrew W. Dick, RAND Corporation in Boston, Massachusetts; and David S. Mandell, Perelman School of Medicine, University of Pennsylvania.
On April 28, 2016, the U.S. Department of Health and Human Services (HHS) strengthened access to health care for individuals transitioning from incarceration back to their communities. New Medicaid guidance released today updates decades-old policy and clarifies that individuals who are currently on probation, parole or in home confinement are not considered inmates of a public institution. It also extends coverage to Medicaid-eligible individuals living in community halfway houses where they have freedom of movement, improving access to care for as many as 96,000 individuals in Medicaid expansion states over the course of the year.
Historically, the vast majority of justice-involved individuals have been uninsured, while experiencing disproportionately high rates of chronic conditions, infectious disease and behavioral health issues. Studies show that roughly half of incarcerated individuals struggle with mental health and substance abuse conditions. Access to the health benefits the Medicaid program covers can play a key role in improving the health of these individuals, and states that expand Medicaid coverage are able to better support the health needs of this population.
“As we celebrate National Re-Entry Week, it is important to understand the critical role access to health care plays in successful returns to the community for so many Americans trying to change their lives,” said Richard Frank, HHS Assistant Secretary for Planning and Evaluation. “Today’s actions will immediately begin to give as many as 96,000 of American’s most vulnerable citizens access to needed health care through Medicaid, including mental health and substance use disorder treatment, reducing the risk they will be re-incarcerated or hurt.”
According to a report released by HHS, there are 2.2 million people currently incarcerated and 4.7 million people under probation or parole in the United States. Because over 95 percent of incarcerated individuals will eventually return to the community, their access to quality health care post-release is an important public health issue. Medicaid coverage connects individuals to the care they need once they are in the community and can help lower health care costs, hospitalizations and emergency department visits, as well as decrease mortality and recidivism for justice-involved individuals.
Through the Affordable Care Act, states have the opportunity to expand Medicaid coverage to individuals, including single childless adults, with household incomes at or below 138 percent of the federal poverty level. Federal funds cover 100 percent of health care costs for the newly eligible population in 2016, scaling down to 90 percent in 2020 and beyond. Medicaid expansion is an important step states can take to address behavioral health needs, including serious mental illness and opioid and other substance use disorders. Nearly 2 million low-income uninsured people with a substance use disorder or a mental illness lived in states that had not yet expanded Medicaid in 2014.
The Obama Administration has taken major steps to make our criminal justice system fairer, more efficient, and more effective at reducing recidivism and helping formerly incarcerated individuals contribute to their communities. To highlight this important work, the Justice Department has designated the week of April 24-30, 2016, as National Reentry Week.
For more information on the Medicaid clarification guidance, visit:
For the report on the importance of Medicaid coverage for criminal justice-involved individuals reentering their communities, visit:
Human rights, economic inequality, access to clean water, and improving educational outcomes are consistent narratives mentioned in the media on a daily basis. Where are the social workers, and why are we missing from the national conversation?
Media outlets are constantly reporting on the challenges and barriers facing teachers, nurses, and law enforcement. However, the social work community appears to be invisible. There is no doubt in my mind that Social Workers are the restorative power and profession of hope, but this power must be manifested into united action. The current structure of our profession promotes fragmentation and isolation of social workers with different focuses into smaller groups.
Social Workers are the single factor that permeates through every spectrum affecting the human condition. Social workers are in hospitals, schools, social service agencies, care facilities, prisons, and police departments. Although we may not use the title, social workers can be found holding positions in the government, private sector, nonprofits, and even in Congress.
I believe that removing barriers preventing intra-communication, collaboration, and sharing of ideas and resources within our profession is the single most important factor in solving issues facing our communities as well as uniting our profession. With the austerity cuts to public agencies, we must be even more innovative in pooling our resources and responding by not being invisible anymore.
Uniting Social Workers with different areas of focus would be the most powerful force needed to address the important issues facing society today. Our different focuses are not our weaknesses, but our strongest attributes collectively. But, we must first elevate our profession’s presence on the global stage.
We must double our public relation efforts in showing our contributions around the world and in our local communities. As social work month starts on March 1st, it’s the best opportunity for us to elevate our profession in the global conversations on poverty, inequality, and human rights.
World Social Work Day 2016
On March 15, 2016, please help @SWHelpercom make the #socialwork trend world-wide on March 15, 2016, on our most important global day of the year. I am asking everyone to tweet out your thoughts, social work resources, research, articles, or just say Hello World using the hashtag #SocialWork all day long. You can utilize Hootsuite or TweetDeck to schedule tweets throughout the day if you are extremely busy.
Social Work allies and organizations who have social workers working within them, join us on this day by tweeting out articles, resources, information, and research to share with our profession.
Children’s rights/advocacy groups and family advocacy groups, we want to hear from you too. Share your thoughts, articles, information, and/or resources social workers should be familiar with.
Let’s see if we make Twitter History on this upcoming World Social Work Day!
In 2008, the Fostering Connections to Success and Increasing Adoptions Act required states to begin developing plans to monitor health care for kids in foster care. This was strengthened in 2011 when the Government Accountability Office(GAO)released a study of child Medicaid populations which found that children in foster care with Medicaid received psychotropic medications at a much higher rate than kids with Medicaid who were not in foster care.
Over the last 10-15 years, efforts tolegislate, increase awareness about the impact of trauma,engage in advocacy for psychosocial therapies and the need forresponsive caregivinghave arisen across the country in an attempt to parallel the reduction of unnecessary or inappropriate psychotropic use for foster kids. In spite of those efforts, there is no question that the overprescribing of psychiatric medications for children in foster carehas proven a tough practice to change.
The issue of psychotropic use in child welfare populations is clearly one where social workers should be at the forefront, it simply does not gain as much involvement as the psychosocial aspects of practice. Social work practitioners may not see it as being within their scope of practice, but kids in care need social work advocacy in this regard more than ever.
There are a number of reasons why psychotropic monitoring and advocacy has been tough to implement. Too many causes to cover in one article, but one factor may be that all of the efforts to build psychosocial approaches have seemed to exist separately from psychotropic monitoring and reduction plans.
Itis unfortunate because better alignment of these initiatives would likely help those living and working with foster care populations to gain a broader perspective and would better illustrate that all therapies, psychosocial or biological, play variable roles. Some states are beginning to implement legislation, but that impact is not yet determined.
Another barrier isthat psychosocial treatment modalities are still behind psychiatric medications in terms of research andevidence-based practice.At present, people may simply be conditioned to be more receptive to a medication therapy. Socially accepted norms and the desire for an instant fix can be difficult obstacles to overcome.Effective systems to assist in tracking and authorization of prescriptions for foster kids, as well as hesitant collaborative and information sharingpractices between government agencies have proven to be barriers for many states.
Understanding the context of the quick fix
Governments will wholeheartedly embrace a practice that is thought to offer a quick solution that also suits a budget and it can be several years before any fallout from a poor decision, lack of resources or policy is noted. Twenty years ago the idea of a chemical imbalance really started to become entrenched in American culture.If too much or too few of certain chemicals caused the imbalance, then a psychiatric medication could restore that imbalance. Psychiatric meds were designed to mimic neurotransmitters in the brain – they would “fix” the imbalance in the brain.
It is true that chemicals are important, but more than biology must be considered in developing treatment plans. The idea, intended or not,that mental illness is due to chemical imbalance has largely become accepted, along with a willingness to medicate childrenas if they will respond exactly as adults. The notion of a ‘chemical imbalance’ is frequently used as the reason for someone’s actions in the everyday vernacular. “It’s not his fault, he has a chemical imbalance!” has been further cultivated by pharmaceutical companies and the general misconception of medication as an easy solution.
While none of this was geared directly towards foster children, they are the vulnerable recipients nonetheless. The focus on becoming trauma informed has directly impacted foster care populations and is gaining greater awareness today than ever before. Trauma informed practices can greatly assist in child welfare, but caution should be taken as well. Trauma informed practice does not represent a quick fix either.
Human beings are too complex. A true implementation of biopsychosocial practicewhich recognizes that age, development, experience, genetics and responsive support each play a role that must be considered in working with kids must be embraced. It is unlikely to be quick or a “fix”, but, in terms of cost it will certainly save in the long run in so many ways.
Polypharmacy and Child Welfare Populations
Kids in care present with a complex variety of behavioral and emotional challenges as a result of chronic poverty, abuse or neglect. They may have unrecognized developmental delays, medical concerns or mental health diagnosesin addition to traumatic experience. In a society where medication has become the accepted first line approach, kids in care are receiving polypharmacy prescribing far more than is appropriate and often without benefit of consistent psychosocial supports. Because foster children can present so intensively, they are susceptible to receipt of psychiatric medicationwhen it may not be warranted.
The effort to medicate behavior, even when no benefit has been realized, makes no sense, but it happens likely increasing the risk of adverse events and placement instability.Caregivers may feel uncomfortable in questioning providers and many do not know what should be monitored and reported. Lack of information and history can be problematic. Providers are often limited in number and in the time they have to give during an office visit. When a foster child refuses a medication, he or she can be accused of noncompliance, but there may be very valid reasons why that child does not wish to comply. Consent is often overlooked or poorly defined.
Side effects associated with some psychotropic medications can outweigh the benefits and clinical trials for children have been in short supply. New science regarding child development suggests that psychiatric medication may have long reaching concerns for children that are not currently understood. In spite of all of the above concerns, efforts to vilify psychotropic use in children should be avoided. Medication can be a helpful therapy, it is simply not the only therapy and it should not be the first type of therapy sought in most cases.
Social Workers need to focus more on psychotropic drug use
Polypharmacy and inappropriate prescribing for foster care populations is more than the latest hot button issue. Efforts have been underway across the nation with varying degrees of limited success for years, often independent of efforts to improve psychosocial supports. There are no easy solutions, a fact that many social workers understand very well. However, social workers can play integral roles in shaping and supporting psychotropic monitoring and oversight at all levels of practice. By improving knowledge, collaboration, highlighting options and advocating for stronger monitoring and consent practices, social workers can make considerable inroads towards positively changing the lives of kids in foster care.
Social workers found victory during the eighth week of the legislative short session with the acceptance of the proposed medicaid budget. On Monday night, the last day of the fiscal year, the Senate rejected the House mini budget, Senate Bill 3 without even voting, and they returned the bill to the House for further consideration. In kind, the House then returned the bill back to the Senate on Tuesday stating they did not follow the rules by rejecting Senate Bill 3 without a vote. This unusual game of ping pong with the budget sent the bill to a committee meeting with the appointed budget conferees and no further discussion happened on the floor of the House or Senate.
On Wednesday, the appointed 41-member budget conferees held an unusual open-to-the-public meeting. During the meeting, differences in the House and Senate budgets were discussed and the group broke into a private negotiating meeting. Upon return to the public meeting, the Senate announced that they would accept the House Medicaid budget with a few compromises that had been made before the meeting starting.
The acceptance of the Medicaid budget means the aged, blind, and disabled citizens on Medicaid will not lose services. We are excited the Senate acted on behalf of our advocacy efforts to save services for these populations. While the Senate agreed to the Medicaid spending, the conferees are still working out differences in teacher pay raises, the education lottery, and film incentives.
Bills with Relevance:
House Bill 1181 North Carolina Medicaid Modernization: This bill was introduced a few weeks ago with controversy in Section 10 regarding a pilot for I/DD patients living in certain group settings to have integrated physical and behavioral health care under Cardinal Behavioral Health. Under the new edition, this section becomes a study with multiple stakeholders involved. The bill was discussed in committee and passed the House with a vote of 113 to 0. The bill now goes to the Senate where support is underwhelming as Senators do not believe this plan, supported by the House and the Governor, will do much to make Medicaid a cost predicting system.
House Joint Resolution 1262 Suicide Prevention Resolution: On Wednesday, House members read the suicide prevention resolution on the floor. The resolution directs the Legislative Research Commission to study ways to prevent suicide among minors and veterans including training for key health care providers that work to assess, treat and manage patients with suicidal ideation. After overwhelming, bipartisan support from legislators who shared personal stories on the floor, the bill passed with no opposition and was sent to the Senate. Following the reading of the resolution, NASW-NC, NAMI-NC, The Mental Health Association, and others were recognized in the gallery by legislators for our support and continued work on suicide prevention in our state. Representative Cunningham (D-Mecklenburg), a primary sponsor of the legislation, gave a heartfelt, personal speech on the bill and credited social workers and educators for help during her family’s situation. We are grateful to the many legislators who stood up to speak on what can be such a tough topic for many.
What to look forward to this week:
Legislators have announced they are finished with committee work. They will use this week to focus on the budget and work out their differences. There are a few more bills expected to be heard on the floor this week but it should mostly be a quiet week with budget work being done behind closed doors.
The ABLE Act has the potential to improve the financial and employability statuses of people with disabilities in this country, if enacted. The Achieve a Better Life Experience (ABLE) Act gained the attention of the disability community when it was first introduced into Congress on February 13, 2013. The ABLE Act was not decided on last year due to the fact that the Congressional session ended before the bill could be considered; however, it has the support of over 400 co-sponsors in the House and Senate. Having such a large amount of support gives many disability advocates, including yours truly, great hope that the Act will be considered and passed this year.
The purpose of the ABLE Act is to prevent disabled savers from losing their benefits by affording them the opportunity to open special tax advantaged saving accounts. Under current policy, those who receive social security benefits such as Supplemental Security Income (SSI) and Medicaid cannot have saving assets of more than $2,000 in an account, and cannot earn income over $700 a month. Those two financial restrictions unfairly places beneficiaries in the proverbial “a rock and a hard place.” If beneficiaries have assets or income that exceed these financial thresholds, their benefits will be cut off. If they decide not exceed these financial thresholds, then their employment and independence opportunities will be severely reduced.
I will give you a fictional example of the “rock and a hard place” choices people with disabilities like myself endure when it comes to wanting to be independent, but fear losing one’s benefits:
“Anita” was offered a part-time telecommuting position that would pay her the current minimum wage rate of $7.25 an hour. Anita currently receives SSI and Medicaid benefits because she has a physical disability. In order to keep her benefits, Anita could only work 24 hours a week, which would total $174 a week of earned income for her. With this weekly schedule, Anita would earn $696 a month before taxes, which would put her under the $700 monthly financial threshold amount by $4.
Anita would have to report her new income source to the Social Security Administration (SSA), which would take into consideration her total earnings, and not the amount Anita actually brings home after taxes. The SSA has a special mathematical formula it utilizes to figure how much of Anita’s earned income should be counted against her benefits. Anita’s monthly wage before taxes was $696; SSA would subtract 85 from this amount, and then divide that amount by 2 to figure how much her SSI benefits for that month should be reduced. So, $696 – 85 would equal $611. $611 divided by 2 would be $305.50. Social Security would count $305.50 against Anita benefits, which would reduce her SSI benefits amount from $721 a month to $415.50 a month. (The 2014 cost of living adjustment (COLA) for SSI beneficiaries is $721.)
This gross reduction of SSI does nothing to elevate Anita out of poverty. Anita would have only $1,111.50 ($415.50 in reduced SSI, and the $696 (before taxes) she earned from working) to live off each month, which is not enough to cover the basic human needs of food, housing, and clothing. This example is not hypothetical; it is fact. This is the dreadful choice people with disabilities have to make: do I work and put my benefits in jeopardy, or do I live off $721 a month that will keep me deep in poverty, and not allow me to be able to afford housing, transportation, entertainment, have an emergency fund, “nest egg” savings, and other “luxuries” that most take for granted?
This is why the passage of the ABLE Act is imperative – it would extinguish the current barrier of working and saving by ensuring that money saved through ABLE accounts would not be counted against the federal benefits an individual receives. The ABLE Act would ease financial strains by allowing the tax-free saving accounts to cover qualified, essential expenses such as medical and dental care, community based supports, employment training, assistive technology, housing, education, and transportation.
The bill would assist in supplementing the benefits they already receive from private insurances, Medicaid, SSI, their employment, and other sources. An ABLE account would provide people with disabilities the same types of flexible saving tools that other Americans have through college savings accounts, health savings accounts, and individual retirement accounts (IRAs). Returning to our example, if the ABLE Act passed, Anita would be able to open an ABLE account where she could deposit her earned income and keep her SSI and Medicaid benefits intact. This newfound freedom would allow people with disabilities to work without the fear of being penalized.
Like millions of Americans with disabilities, I am anxiously waiting for the passage of the ABLE Act. From a personal standpoint, the ABLE Act would open a plethora of doors for me as an entrepreneur and a freelance writer. Not having to worry about how much I earn or how much I have saved would be a joyous moment. People with disabilities want the same things as everyone else – to work, have healthcare coverage, and be able to living independently and support themselves and those they love. The ABLE Act would turn those hopes into reality. Please urge your federal representatives to support and pass the ABLE Act this year because it is long overdue.
(Featured headlining image: Courtesy of The Denver Channel.)
Economists Gary S. Becker and Julio J. Elias propose in the Wall Street Journal that they have calculated a system of legal payments for kidney donations that would cut costs and reduce shortages in America.
The authors propose a system in which making it legal to pay someone for one of their kidneys is economically feasible on a national scale, while dramatically cutting down the time patients would need to wait for a matching donor. At face value, the proposal sounds good. However, as someone who studies the plight of the most vulnerable and exploitable, I must say that such a system would need to be accompanied by highly stringent informed consent safeguards — probably more stringent than the informed consent envisioned by the authors.
Hypothetical scenarios that are formulated in a “vacuum” where all things are equal often grossly underestimate the ingenuity of the underground business world. Organized criminal activity has an uncanny ability to coerce or exploit the most vulnerable in societies — much like organized criminal activity that exploits business ethics on Wall Street.
According to the authors,
We have estimated how much individuals would need to be paid for kidneys to be willing to sell them for transplants. These estimates take account of the slight risk to donors from transplant surgery, the number of weeks of work lost during the surgery and recovery periods, and the small risk of reduction in the quality of life.
Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about $15,000 for each kidney. That estimate isn’t exact, and the true cost could be as high as $25,000 or as low as $5,000—but even the high estimate wouldn’t increase the total cost of kidney transplants by a large percentage. Read More
The authors state that “the sale of organs would make them more available to the poor, and Medicaid could help pay for the added costs of transplant surgery.” This statement serves to suggest that a system of legal payment for kidney donations would benefit not just the rich, but the poor. While there is merit to this statement, it is worth noting that the authors’ definition of “poor” involves the word Medicaid.
This qualifier excludes the vast majority of poor people in the world, the very people who would be exploited by illegal organ traders. And, in light of the authors’ statement that “today, the rich often don’t wait as long as others for organs since some of them go to countries such as India, where they can arrange for transplants in the underground medical sector,” I see evidence of the very concern I am here presenting.
The authors’ proposal is very noble and I think that it is worth considering. They are conscientious about weighing costs in a situation that presents multiple moral dilemmas. However, as with any market where there is already evidence that the most vulnerable are exploited, we must proceed with caution.