47
1 Social Security and Medicare & Medicaid NURS 4100 Care of the Older Adult Spring 2014 Joy A. Shepard, PhD(c), MSN, RN, CNE

Social security and medicare & medicaid spring 2014 abridged

Tags:

Embed Size (px)

DESCRIPTION

 

Citation preview

Page 1: Social security and medicare & medicaid spring 2014 abridged

1

Social Security and Medicare & Medicaid

NURS 4100 Care of the Older Adult Spring 2014Joy A. Shepard, PhD(c), MSN, RN, CNE

Page 2: Social security and medicare & medicaid spring 2014 abridged

2

Objectives

Analyze the benefits of Social SecurityDiscuss the phenomenon of retirement

as it relates to an aging societyCompare and contrast the Medicare

and Medicaid programsList the benefits and barriers to long-

term care insurance

Page 3: Social security and medicare & medicaid spring 2014 abridged

3

Changing Demographics

Page 4: Social security and medicare & medicaid spring 2014 abridged

4

Changing Demographics

Year 2001

Year 2011

Year 2021

Page 5: Social security and medicare & medicaid spring 2014 abridged

5

Age & Sex Structure of the US Population: 2010, 2030, & 2050

Page 6: Social security and medicare & medicaid spring 2014 abridged

6

Shifting Composition of the Workforce

Page 7: Social security and medicare & medicaid spring 2014 abridged

7

Social Security

Page 8: Social security and medicare & medicaid spring 2014 abridged

8

Social Security

Social Security Act of 1935 Federal Federal public retirement pension systemFull retirement age steadily rising (since

1980s)Major source incomeHas decreased poverty ratesMajor recipients female elderly

Page 9: Social security and medicare & medicaid spring 2014 abridged

9

Social Security

QualificationsFinancially sustainable? No means testProcrastination – bad policyWhat suggestions do YOU have to

save Social Security?Text of the 1935 Social Security Act

Page 10: Social security and medicare & medicaid spring 2014 abridged
Page 11: Social security and medicare & medicaid spring 2014 abridged
Page 12: Social security and medicare & medicaid spring 2014 abridged

Review Question

Which of the following factors would not threaten the solvency of Social Security?

A. Baby Boomers taking early retirement. B. Means testing being implemented for Social

Security. C. Another recession or depression. D. Aging of the population.

12

Page 13: Social security and medicare & medicaid spring 2014 abridged

Retirement in an Aging Society

13

Page 14: Social security and medicare & medicaid spring 2014 abridged

Retirement

Phenomenon of retirement – How will it be redefined by the Boomers?

Decades of retirement - feasible?Social Security sufficient?Are Boomers prepared?“Third Age” career strategies

14

Page 15: Social security and medicare & medicaid spring 2014 abridged

Income Older Adults in America

15

Page 16: Social security and medicare & medicaid spring 2014 abridged

16

Medicare & Medicaid

Page 17: Social security and medicare & medicaid spring 2014 abridged

17

Medicare

Title XVIII of the Social Security Act (1965) Covers elderly and some disabled

– Part A – Hospital insurance– Part B

Supplemental medical insurance (physician care)Preventive services

Limited means test Covers ~ 45% of elders’ medical care bills

Page 18: Social security and medicare & medicaid spring 2014 abridged

18

Medicare Preventive Services

Prevention is any activity that reduces the burden of mortality or morbidity from disease. Services performed in a clinical setting that are designed to prevent disease, injury, or disability, prolong life, and promote health are known as preventive health services.

Examples: Screening, testing, counseling, immunization, preventive medication, and preventive treatment.

Help people avoid disease or injury (primary), delay the onset of disease (primary), detect disease in its earliest and most treatable state (secondary), or alter and change the course of chronic conditions by restoring function and reducing complications (tertiary).

Result: Longer, healthier, and more productive lives.

Page 19: Social security and medicare & medicaid spring 2014 abridged

19

Medicare Preventive Services (Part B):

One-time “Welcome to Medicare” preventive visit

Abdominal aortic aneurysm screening Alcohol misuse screenings and counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Colorectal cancer screenings Depression screenings Diabetes screenings

Page 20: Social security and medicare & medicaid spring 2014 abridged

20

Medicare Preventive Services Cont’d…

Diabetes self-management training  Glaucoma tests HIV screenings Mammograms (screening)  Nutrition therapy services Obesity screenings and counseling Pap tests and pelvic exams (screening) Prostate cancer screenings Sexually transmitted infections screening and cou

nseling

Page 21: Social security and medicare & medicaid spring 2014 abridged

21

Medicare Preventive Services Cont’d…

Shots: – Flu shots – Hepatitis B shots – Pneumococcal shots

Tobacco use cessation counseling Yearly "Wellness" visit http://www.medicare.gov/coverage/preventive-and-screening-ser

vices.html

Page 22: Social security and medicare & medicaid spring 2014 abridged

22

Medicare Related Resources

Medicare & You: Stay Healthy with Medicare’s Preventive Benefits (video)

Medicare & You: Women's Preventive Health (video)

Page 23: Social security and medicare & medicaid spring 2014 abridged

23

Medicare

Medicare Advantage – Part C

Voluntary Prescription Drug Benefit – Part D

Page 24: Social security and medicare & medicaid spring 2014 abridged

24 http://downloads.cms.gov/files/TR2013.pdf

Page 25: Social security and medicare & medicaid spring 2014 abridged

25

Question

Hospital insurance for Medicare recipients is funded under:– A. Medicare Part A– B. Medicare Part B– C. Medicare Part C– D. Medicare Part D 

Page 26: Social security and medicare & medicaid spring 2014 abridged

26

Medigap – Medicare Supplemental Insurance Policies

Medicare Supplemental Insurance

Private insurance – helps seniors pay for costs not covered by Medicare

Page 27: Social security and medicare & medicaid spring 2014 abridged

27

Page 28: Social security and medicare & medicaid spring 2014 abridged

28

Medicare

Covers (with some limitations):– Skilled nursing in nursing facilities and subacute care

– Home health care– Hospice

Page 29: Social security and medicare & medicaid spring 2014 abridged

29

Medicare no longer covers the cost of 10 hospital-acquired conditions

Foreign object retained after surgery

Air embolism Blood incompatibility Stage III & IV pressure

ulcers Falls & trauma

Poor glycemic control Catheter-assoc UTI Vascular catheter-

associated infection Certain surgical site

infections (CABG, bariatric, orthopedic)

DVT or PE following TKR, hip replacement

For more information, please see http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp#TopOfPagehttp://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3227&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

Page 30: Social security and medicare & medicaid spring 2014 abridged

30

Review Question

Medicare recently issued a new ruling. It will cease paying for 10 preventable hospital-acquired conditions. Which of the following conditions are included in the new ruling?– A. Hematoma after venipuncture– B. Skin tear after being turned and

repositioned– C. Cellulitis after IV infusion– D. Pneumonia after aspirating on meal tray 

Page 31: Social security and medicare & medicaid spring 2014 abridged

31

Medicaid

Title XIX Social Security Act (1965)Covers “medically indigent”Funded partly by federal and partly by Funded partly by federal and partly by

state governmentsstate governmentsRun by states under federal guidelinesRun by states under federal guidelinesNorth Carolina statistics

North Carolina Medicaid State PlanNorth Carolina Division of Medical Assistance

Page 32: Social security and medicare & medicaid spring 2014 abridged

Latest Data: NC Medicaid Enrollments & PaymentsFMAP: Federal Share of Medicaid Costs

Rising Enrollments Federal Share/ State Share: 65.5%/ 34.5%

32

Page 33: Social security and medicare & medicaid spring 2014 abridged

33

Medicaid

Covers (depending on state’s program):– Nursing care

facilities– Assisted living– Home health

Page 34: Social security and medicare & medicaid spring 2014 abridged

34

Affordable Care Act of 2010 Expands Medicaid Eligibility in 2014

The Affordable Care Act of 2010, signed by President Obama on March 23, 2010, creates a national Medicaid minimum eligibility level of 133% of the federal poverty level ($29,700 for a family of four in 2011) for nearly all Americans under age 65.

This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date-see related Federal Policy Guidance and states that have expanded Medicaid prior to 2014.

States can also choose to opt out of the expansion. See eligibility provisions in the Affordable Care Act.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html

Page 35: Social security and medicare & medicaid spring 2014 abridged
Page 36: Social security and medicare & medicaid spring 2014 abridged

36

Page 37: Social security and medicare & medicaid spring 2014 abridged

37

Page 38: Social security and medicare & medicaid spring 2014 abridged

38

Page 39: Social security and medicare & medicaid spring 2014 abridged
Page 40: Social security and medicare & medicaid spring 2014 abridged
Page 41: Social security and medicare & medicaid spring 2014 abridged

41

Page 42: Social security and medicare & medicaid spring 2014 abridged

Review Question

What is federally mandated and state administered?

A. MedicaidB. Medicare

42

Page 43: Social security and medicare & medicaid spring 2014 abridged

Review Question

_________ is a $498 billion public health insurance program for low-income individuals and the largest long-term care program for the disabled and elderly.

A. MedicaidB. Medicare

43

Page 44: Social security and medicare & medicaid spring 2014 abridged

Review Question

Which of the following applies to Medicare and which applies to Medicaid? A. Federally administered, nationwide healthcare coverage program for elderly/ disabled B. Entitlement program—all individuals have a legal right to apply for the program; if they

meet the eligibility criteria, they are entitled to receive coverage C. Uniform: one set of requirements applies to all participating providers/ beneficiaries D. Joint federal/ state partnership: healthcare coverage for low-income individuals E. Differences among state programs: covered populations, benefits, cost sharing,

delivery systems and reimbursement to providers F. Means-tested program that provides benefits to certain categories of people who meet

rigorous income and asset rules G. States may cover other individuals under “waiver” programs H. Every state has a limit on what things (“assets”) a recipient may own and keep

44

Page 45: Social security and medicare & medicaid spring 2014 abridged

45

Ethical Issue: Transfer of Assets & “Spend Down”

Is transferring assets to qualify for Medicaid ethical?

Right to leave assets to children?

Should wealthy be subsidized?

Punished for being frugal?

Page 46: Social security and medicare & medicaid spring 2014 abridged

46

Long-Term Care Insurance

Page 47: Social security and medicare & medicaid spring 2014 abridged

47

Long-Term Care Insurance

Plan ahead for LTC costsMainly people over age 554-10% older population

coveredProvides 7% of total funding

for LTC


Centers for Medicare & Medicaid Services - Medicaid Education

Centers for Medicare & Medicaid Services - Medicaid Education

Documents
Medicare, Medicaid, and CHIP · Medicare, Medicaid, and CHIP April 2013 CMS National Training Program . 1. Introduction to Medicare 2. Medicaid and new eligibility group 3. Children’s

Medicare, Medicaid, and CHIP · Medicare, Medicaid, and CHIP April 2013 CMS National Training Program . 1. Introduction to Medicare 2. Medicaid and new eligibility group 3. Children’s

Documents
The lessons in this module, “Medicare and Medicaid Fraud ... · The lessons in this module, “Medicare and Medicaid Fraud and Abuse Prevention,” explain Medicare and Medicaid

The lessons in this module, “Medicare and Medicaid Fraud ... · The lessons in this module, “Medicare and Medicaid Fraud and Abuse Prevention,” explain Medicare and Medicaid

Documents
Hearing from Medicare-Medicaid Enrollees: Findings from 2011 Focus Groups Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services

Hearing from Medicare-Medicaid Enrollees: Findings from 2011 Focus Groups Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services

Documents
Medicaid Comm Network Kick-Off Presentation (Abridged)

Medicaid Comm Network Kick-Off Presentation (Abridged)

Documents
Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid...Presenting a live 90‐minute webinar with interactive Q&A Medicare and Medicaid

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid...Presenting a live 90‐minute webinar with interactive Q&A Medicare and Medicaid

Documents
Centers for Medicare & Medicaid Services - MDPCP... · 2018-05-21 · Centers for Medicare & Medicaid Services . Center for Medicare and Medicaid Innovation . State Innovations Group

Centers for Medicare & Medicaid Services - MDPCP... · 2018-05-21 · Centers for Medicare & Medicaid Services . Center for Medicare and Medicaid Innovation . State Innovations Group

Documents
Medicare & Medicaid

Medicare & Medicaid

Documents
MC Medicaid Medicare 062420 · Medicare & Medicaid Compared MEDICARE MEDICAID National program, consistent across the country. Statewide programs, varies among states. Administered

MC Medicaid Medicare 062420 · Medicare & Medicaid Compared MEDICARE MEDICAID National program, consistent across the country. Statewide programs, varies among states. Administered

Documents
Improving Care for Medicare-Medicaid Enrollees Marc Steinberg Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 5,

Improving Care for Medicare-Medicaid Enrollees Marc Steinberg Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 5,

Documents
Medicare & Medicaid EHR Incentive Program Final Rule · Medicare & Medicaid EHR Incentive Program Final Rule. ... What is in the Medicare & Medicaid EHR Incentive Program Final Rule?

Medicare & Medicaid EHR Incentive Program Final Rule · Medicare & Medicaid EHR Incentive Program Final Rule. ... What is in the Medicare & Medicaid EHR Incentive Program Final Rule?

Documents
Pathways to Medicare Medicaid Eligibility: A Literature · PDF filePathways to Medicare‐Medicaid Eligibility: A Literature Review ... Pathways to Medicare-Medicaid eligibility: A

Pathways to Medicare Medicaid Eligibility: A Literature · PDF filePathways to Medicare‐Medicaid Eligibility: A Literature Review ... Pathways to Medicare-Medicaid eligibility: A

Documents
Medicare Medicaid Summaries 2013

Medicare Medicaid Summaries 2013

Documents
Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid-audit... · Medicare and Medicaid Audit Sampling Strategies ... –Number of claims

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid-audit... · Medicare and Medicaid Audit Sampling Strategies ... –Number of claims

Documents
Integrating Care for Individuals Eligible for Medicare and Medicaid Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services June

Integrating Care for Individuals Eligible for Medicare and Medicaid Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services June

Documents
CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You/media/Files... · CENTERS FOR MEDICARE & MEDICAID SERVICES & Medicare. Y. ou. 2012. This is the official U.S. government . Medicare

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You/media/Files... · CENTERS FOR MEDICARE & MEDICAID SERVICES & Medicare. Y. ou. 2012. This is the official U.S. government . Medicare

Documents
Transitions from Medicare-Only to Medicare-Medicaid EnrolleeMME Medicare-Medicaid Enrollee SNF Skilled Nursing Facility SSI Supplemental Security Income 1 INTRODUCTION Medicare-Medicaid

Transitions from Medicare-Only to Medicare-Medicaid EnrolleeMME Medicare-Medicaid Enrollee SNF Skilled Nursing Facility SSI Supplemental Security Income 1 INTRODUCTION Medicare-Medicaid

Documents
Data Analysis Brief Medicare-Medicaid Dual Enrollment from ... · Data Analysis Brief Medicare-Medicaid Dual Enrollment from 2006 through 2011 Prepared by Medicare-Medicaid Coordination

Data Analysis Brief Medicare-Medicaid Dual Enrollment from ... · Data Analysis Brief Medicare-Medicaid Dual Enrollment from 2006 through 2011 Prepared by Medicare-Medicaid Coordination

Documents
C MEDICARE MEDICAID SERVICES

C MEDICARE MEDICAID SERVICES

Documents
Medicare and Medicaid Repayments and Disclosuresmedia.straffordpub.com/products/medicare-and-medicaid-repayments... · Medicare and Medicaid Repayments and Disclosures ... Robert

Medicare and Medicaid Repayments and Disclosuresmedia.straffordpub.com/products/medicare-and-medicaid-repayments... · Medicare and Medicaid Repayments and Disclosures ... Robert

Documents
Navigating Medicare...Medicare & Medicaid (Dual) • Called “Dual-eligible” or “Duals” • Medicare costs are covered • Medicare pays first, Medicaid second, IHS last *unless

Navigating Medicare...Medicare & Medicaid (Dual) • Called “Dual-eligible” or “Duals” • Medicare costs are covered • Medicare pays first, Medicaid second, IHS last *unless

Documents
Centers for Medicare & Medicaid Services OUTREACH … · Centers for Medicare & Medicaid Services OUTREACH TO DATA ... 2 series of the Centers for Medicare & Medicaid Services

Centers for Medicare & Medicaid Services OUTREACH … · Centers for Medicare & Medicaid Services OUTREACH TO DATA ... 2 series of the Centers for Medicare & Medicaid Services

Documents
Medicare Advantage and Dual Medicare-Medicaid Plans

Medicare Advantage and Dual Medicare-Medicaid Plans

Documents
Medicaid Coverage of Medicare Beneficiaries (Dual ...learning.rxassist.org/.../medicare_beneficiaries_dual_eligibles_at... · Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles)

Medicaid Coverage of Medicare Beneficiaries (Dual ...learning.rxassist.org/.../medicare_beneficiaries_dual_eligibles_at... · Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles)

Documents
Centers for Medicare & Medicaid Services Center for Medicare

Centers for Medicare & Medicaid Services Center for Medicare

Documents
Module: 10 Medicare and Medicaid Fraud Prevention · PDF fileModule: 10 Medicare and Medicaid Fraud Prevention . Inside Front Cover . i Module 10: MEDICARE & MEDICAID FRAUD PREVENTION

Module: 10 Medicare and Medicaid Fraud Prevention · PDF fileModule: 10 Medicare and Medicaid Fraud Prevention . Inside Front Cover . i Module 10: MEDICARE & MEDICAID FRAUD PREVENTION

Documents
Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011

Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011

Documents
Centers for Medicare & Medicaid Services, Medicaid ... · Centers for Medicare & Medicaid Services Medicaid Integrity Program . Annual Summary Report . of . Comprehensive Program

Centers for Medicare & Medicaid Services, Medicaid ... · Centers for Medicare & Medicaid Services Medicaid Integrity Program . Annual Summary Report . of . Comprehensive Program

Documents
CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You 2010

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You 2010

Documents
Improving Care for Medicare-Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 19, 2015

Improving Care for Medicare-Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 19, 2015

Documents