Institute Talk: A Conversation with Daughterhood Founder Anne Tumlinson on Challenges of Caring for Aging Parents

Anne Tumlinson is the nationally recognized eldercare expert who founded Daughterhood, an online community providing support and advice to adult children caring for their aging parents. She is also the founder of Anne Tumlinson Innovations, a research and advisory firm focused on transforming the way care is delivered and financed.

With more than 25 years of research and consulting experience, Tumlinson has often testified in Washington and written on innovation in aging services. Previously, she led Medicaid program oversight at the federal Office of Management and Budget.

Recently she talked with Gerontology Institute Director Len Fishman about the evolution of Daughterhood, practical problems facing caregivers and policy issues that affect innovation in the field. The following is an edited version of their conversation. Continue reading

How to Measure Real Potential Cost of New Health Care Legislation for Elders

By Marc Cohen and Kris Wiitala

Both the House-passed version of ACA repeal legislation, the American Health Care Act (AHCA), and the Senate’s version currently under deliberation – the Better Care Reconciliation Act (BCRA) – include a particularly debilitating change: a per capita cap system of funding for Medicaid. This change would dramatically cut federal Medicaid funding to states. It would force states to make difficult decisions between benefit cuts, provider payment cuts and changes to eligibility requirements – or all of these in varying measure – in order to balance their budgets. Analyses have pointed out how a per capita cap system would lead to significant underfunding of long-term services and supports (LTSS), penalize adults and children with disabilities, lead to significant shortfalls in state funding and cause financial challenges for providers. Continue reading

Assessing Potential Impact of Medicaid Caps on States, Care Workers

The American Health Care Act under consideration in the U.S. Senate would create varying degrees of economic stress on individual states and could lead to the elimination of as many as 713,000 jobs held by home health and personal care aides, according to new research prepared by UMass Boston Gerontology Professor Marc Cohen.

The legislation, which has been passed by the House, would place limits on spending for Medicaid in the future. The report by Cohen, who is co-director of the LeadingAge LTSS Center @ UMass Boston, identifies which states could be more vulnerable to those cuts. Continue reading

Rhode Island: The Test Case That Never Was for Medicaid Restructuring

By Edward Alan Miller
Professor of Gerontology and Public Policy
McCormack Graduate School

Although ultimately withdrawn before a vote, the American Health Care Act (AHCA) proposed by House Republicans would have radically restructured Medicaid by converting the federal government’s open-ended commitment to match state government spending with a per-capita cap on the amount of money a state could receive for each enrollee. An alternative to per-capita caps, Medicaid block grants, is also favored by some Republicans but was not included in this particular proposal. Block grants would replace the federal government’s open-ended financial commitment with a fixed up-front annual allotment for the entire covered population.

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How Medicaid Per Capita Caps Will Affect those Needing Long-Term Services and Supports

By Marc A. Cohen, Ph.D., Michael Miller, MA, Leena Sharma, MPP

Earlier this week, the Republicans in the House of Representatives put forward their plan – the American Health Care Act (AHCA) — for the repeal and replacement of sections of the Affordable Care Act (ACA).  In addition to repealing the health-related tax and subsidy provisions in the ACA, replacing them with refundable tax credits, the plan also changes the Medicaid program from a federal-state partnership to a per capita cap program.  More specifically, Section 121 of the Act would use each State’s spending in FY2016 as a base year to set targeted spending for each enrollee category in FY2019 (and subsequent years) for that state.  Each state’s targeted spending amount would increase by the percentage increase in the medical care component of the consumer price index for all urban consumers from September 2019 to September of the next fiscal year.  The enrollee categories for which separate caps would be established include the: (1) elderly, (2) blind and disabled, (3) children, (3) non-expansion adults, and (4) expansion adults. Continue reading