Tag: Medicare


Why Consider PACE Program for the Future

Why PACE program of all inclusive care for the elderly

Why PACE: program of all inclusive care for the elderly

Programs of All-inclusive Care for the Elderly (PACE) serve seniors with chronic care needs by providing access to the full continuum of preventive, primary, acute, and long term care services. PACE Programs California take many familiar elements of our traditional health care system and reorganize them in a way that makes sense to families, health care providers and the government programs and others that pay for care.

PACEFor consumers, PACE provides:

  • Caregivers who listen to and can respond to their individualized care needs
  • The option to continue living in the community as long as possible
  • One-stop shopping for all health care services

For health care providers, PACE provides:

  • Capitated funding arrangement rewards providers that are flexible and creative in providing the best care possible
  • Ability to coordinate care for the individuals across settings and medical disciplines
  • Meets increasing consumer demands for individualized care and supportive services arrangements

For those who pay for care, PACE provides:

  • Cost savings and predictable expenditures
  • Comprehensive service package emphasizing preventive care that is usually less expensive and more effective than acute care
  • A model of choice for older individuals focused on keeping them at home and out of institutional settings

What is PACE and how is PACE Paid for?

Medicare PACE ProgramWhat is PACE? PACE is a fully capitated program in which the Centers for Medicare PACE Program and Medicaid Services (CMS) pays the Medicare capitation, and each State establishes and pays the Medicaid capitation. These capitated payments are combined at the provider level, creating a flexible funding pool for all primary, acute and long term care services.

The goal of rate setting for PACE is to establish capitation rates that are acceptable to both providers and payers. In general, the Medicare capitation payment is about one-third of the payment PACE providers receive for each enrollee.

Why Consider PACE for the Future

  • PACE provides a full range of preventive, primary, acute and long term care services that enable frail older individuals to live in the community as independently as possible
  • PACE provides care and services consistent with emerging consumer demands for individual choices in health care and services
  • PACE combines adult day settings, home care, interdisciplinary teams, transportation systems and capitated payment systems so that providers can respond to the unique needs of each frail elderly individual served
  • Twenty-six providers have successfully replicated the PACE model, demonstrating the value of high quality, individualized care PACE provides for its participants. Eleven other providers are operational and on their way to developing PACE programs

 

Difference Between Medicare and Medicaid and Medi-Cal

Medicaid

Anyone who begins looking into long-term care options will quickly run into the terms Medicare, Medicaid and Medi-Cal. Many people are confused but these are three different programs. In today’s post, Let’s do our best to give you a basic overview of the three different programs.

Let’s talk about the three M’s. The Medicare, Medicaid and Medi-Cal.

MedicareSo these terms are used a lot for seniors because they are the medical services that you receive once you reach age 65. But there is a ton of confusion around them. And unfortunately the names are so close to each other, that people often interchange them and use them alternately when their very different programs.

Let’s start with a few definitions to kind of clarify things for folks.

The first is, what is Medicare?

(Medicare) is probably the most common government benefit that seniors are able to take advantage of next to Social Security. What it is, is it’s the medical coverage for seniors over the age of 65. So, it covers doctor visits. It covers prescriptions. It covers hospital stays and to a certain extent it will cover some long term care or some skilled nursing stay if you’re rehabilitating from a surgery. But it is the most common and you often get it when you’re 65. That means you stop having to pay private health coverage premiums. And it’s the most common program out there. It is very different from Medicaid.

So, M-E-D-I-C-A-I-D.

Medicaid is a federal and state medical program for seniors that allows for payment if that person is age and disabled and they qualify, asset wise or financially, for this service. It’s a form of welfare. You apply for Medicaid at the wealth your local county welfare office. And it will provide for the majority of the costs of a stay in a skilled nursing facility. It also provides for in-home care if you qualify. For in-home caregivers to come in if you have a long term illness. And in some states it will cover assisted living – not in California.

The final M, Medi-Cal.

long-term careAnd that is California’s version of Medicaid. So again, it’s administered through the welfare department in your county. So that’s where you would apply. That’s you know, you would get assigned a social worker. And those are where the services would derive from. It is a different program in California as it’s different in every other state. In California the qualification requirements are different than any other state.

If You’re Googling Medicaid and Medi-Cal, you’re going to get some mixed information. So, the recommendation is if any of you need Medicaid or Medi-Cal, you should contact an experienced attorney who works in this area. Because, the rules and regulations are very complicated and it is risky to go it alone.

That is the difference between Medicare, Medicaid, Medi-Cal. This might have confused you even more, don’t know. But always, when push comes to shove and you need to get information.

Don’t google it, give a an experienced attorney call or visit.