The American Association of Retired Persons (AARP) Public Policy Institute reports that two-thirds of the states are integrating Medicare and Medicaid for those with dual eligibility. One of these states is Rhode Island, which recently launched its Integrated Care Initiative.
An Increase in Elderly Population Expected in Rhode Island
A report released by the Rhode Island Division of Planning expects the state’s senior citizen population to increase by approximately 75 percent in the next 30 years. This means an increase from about 150,000 to 265,000, according to Providence Business News. Rhode Island’s Executive Office of Health and Human Services (HHS) created an Integrated Care Initiative program to help seniors and disabled adults navigate the health care system. The goal of the initiative is to reduce the number of residents that live in nursing homes. The 28,000 eligible residents will receive letters explaining the new initiative. The initiative automatically enrolls those who are eligible for the program; however, they can opt out.
The Initiative Helps Those with Dual Eligibility
This initiative provides health coverage to the dual eligible elderly and disabled adults in Rhode Island. A dual eligible individual is one who qualifies for both Medicaid and Medicare. Medicaid is the state-federal program for the poor and Medicare is the federal health insurance program for elderly and disabled Americans. Whereas Medicare will not cover nursing home care on a long-term basis, Medicaid will. A nursing home resident without Medicaid can easily deplete her savings. Rhode Island’s Integrated Care Initiative is combining Medicaid and Medicare benefits into a single plan.
Private Insurers Run the Plans
Private insurers will run these plans, receiving a monthly fee from each enrollee. The Neighborhood Health Plan of Rhode Island (NHPRI) is one of the top 10 Medicaid managed care organizations in the nation and is the initiative’s main contractor, according to GoLocvalProv.com.
Rhode Island Spends About $35 Million a Month on Long-Term Care
Steven Costantino is the secretary for Rhode Island’s Executive Office of Health and Human Services. Constantino states that for years, Rhode Island’s long-term care has favored institutional settings like nursing homes. Constantino continues stating that the state spends approximately $35 million every month on long-term medical care. Nursing homes receive $27 million; the remaining $8 million goes to community-based health care such as hospice, assisted living and adult day care, according to ProvidenceJournal.com.
Allow Rhode Island’s Seniors to Choose Their Own Community
If the HHS can reduce the number of people in nursing homes, taxpayers will save money and the elderly residents of Rhode Island can choose to live in elderly communities like Emeritus senior living apartments. These types of communities allow seniors to remain independent as long as possible, yet provide them with whatever they need (cooked meals, medical care, transportation).
Understanding the Role of the Initiative
This initiative helps elderly individuals navigate the health care system, serving as the care manager for integrating their hospital, nursing home and community services. It seeks to organize their care across all medical services including specialty, primary, long-term, and behavioral health care.
The initiative:
- Ensures they receive a safe nursing home discharge
- Helps arrange for them to have any home modifications they need (such as grab bars and raised toilet seats in their bathrooms)
- Makes sure they have the services and supports available to them
- Monitors them once they return home, making sure they feel comfortable and safe, instead of isolated
Katie Nicholson
Katie is a retired nurse and freelance writer who writes about the health care industry for a number of web sites.