In Virginia, there are over one million people age 60 and older and over 90,000 Virginians age 85 and older. These figures will only grow in the upcoming decades.  Thus will put increasing strain on public programs and will require service providers to reorient medical care toward providing continued, high-quality long term care services.  Long term care is of growing importance to health care sector.  Although the aged and disabled populations make up 30% of Virginia’s Medicaid population, these individuals account for 70% of the state’s $4 billion Medicaid budget.

Yet providing long term care to those in need is a confusing a bureaucratic process.  For instance, in Virgina, there are 6 agencies that provide long term care services:

• The Virginia Department of Health (VDH) oversees licensure and certification for home health agencies, home care organizations, and nursing facilities. VDH also has programs aimed at reducing falls and managing chronic diseases such as diabetes, cardiovascular disease, and arthritis for the elderly and individuals with disabilities.
• The Virginia Department of Aging (VDA) works with 25 local Area Agencies on Aging (AAA) and other public and private organizations to help older Virginians maintain their independence and avoid inappropriate or unnecessary institutionalization.
• The Department of Medical Assistance Services (DMAS) funds the majority of long-term support and community based care services provided across the state through Medicaid-funded home and community-based care waivers. Virginia currently operates seven of these waivers.  In Fiscal Year 2004, DMAS provided care to 208,503 aged, blind and disabled beneficiaries at a cost of almost $2.6 billion dollars.
• The Deparment of Mental Health, Mnetal Retardation, and Substance Abuse Services (DMHMRSAS) is not just a horrible acronym.  The department also works with 40 Community Services Boards (CSBs) to provide mental health and substance abuse services.  DMHMRSAS and the CSBs also directly operate the Mental Retardation and Day Support Medicaid home and community-based waivers.
• The Department of Rehabilitative Services (DRS) collaborates with the public and private sectors to provide a variety of employment related community services including consumer-directed personal assistance program.
• The Department of Social Services (DSS) coordinates services with 120 local departments of social services to assist needy individuals.

To summarize, there are 6 state government departments, 120 local DSS, 25 AAA’s, 34 health departments, 16 Centers for Independent Living, 40 local CSBs, as well as faith-based organizations and non-profits.  Each of these organizations provides a different components necessary for quality long-term care.  Additionally, although referral are encouraged, there is no automated system for making these referrals.

According to the Age in Action newsletter, “In 2005, the Virginia General Assembly passed House Joint Resolution Number 657, which requested the Secretary of Health and Human Resources to study the development of a No Wrong Door approach for Virginia’s long-term support service system; it would give providers a more seamless method to share information about an individual for whom they provide services, and would spare applicants the process of answering the same questions over and over again.”  Allowing aged and disabled individuals to access the care they need however they enter the social services system would streamline benefits processing and improve beneficiary quality of life.

One of the efforts Virginia has come up with is SeniorNavigator.org, which connects seniors with a variety of community resources.  Virginia already has a No Wrong Door system for its children’s health insurance under the Family Access to Medical Insurance Security (FAMIS) Plan.  Other states, such as Ohio, have also implemented their own No Wrong Door systems.  Additional streamlining of services and coordination between the public and private sector is necessary in order for the No Wrong Door initiatives to decrease cost and improve beneficiary quality of life.

Source: Jason Shafrin

St. Bernards Health and Wellness Institute, Jonesboro

Local preschool is trying to pick up the pieces after flooding
The 3-year-olds, excited about their trip to the wading pool, are giving no thought to their cramped, flood-damaged quarters.  They could be reciting their ABCs in a dark coat closet and it wouldn’t matter. Chatty and fidgety, they’re psyched for the fun to come.
A month [...]

Source: Erin Egan

Debates continue about the impact of health reform on small businesses. Mine is a small business so I’ve been paying close attention. I’ve even read every line of this legislation – three times. And every pundit analysis I can get my hands on.

My role as a strategist requires that I understand the law. My role as a business owner requires that as well. Most analyses make broad-brush statements and it’s not possible to know the full impact until each business does its own analysis. Here’s mine

Unfortunately, there are no ‘upsides’ for my employees or business:

• My company is too small to be required to provide health insurance. That’s of no matter, I’ve been providing it all along.
• My company is unlikely to grow to the size required to provide health insurance. That’s of no matter, I’d do it anyway. As an employer I know the value of a healthy workforce.
• My company is too busy to even consider applying for grant funds for worksite health promotion and disease prevention. We’d lose productive work hours watching for RFPs, framing proposals and even more complying with paperwork. That’s of no matter, I’ve been providing that all along as well.
• My company is composed of workers too highly compensated to qualify for insurance tax credits, and I suspect no company like mine will qualify either. My employees are knowledge workers with advanced degrees and compensation above the $50,000 annual ceiling for the tax credit provisions.

Unfortunately  there are ‘downsides’ for my business, all related to new IRS rules.

Section 9006 mandates that about 18 months from now, my business – which really means my Executive Assistant, who is already plenty overloaded – will be required to issue 1099 tax forms to any individual or company from which by more than $600 in goods and services.   

We already issue an IRS Form 1099 to people like freelancers who are not ‘incorporated’ business entities. In any given year, that number ranges from 10-14.

That means we don’t send a 1099 to other incorporated businesses, that is, to Amazon, Amtrak, US Airways, Continental Airways, British Airways, Air France, Westin Hotels, Marriott Hotels, Holiday Inns, Kinko’s, Federal Express, Staples, Office Supply, Office Doctor, IT Edge, Samsung, Independence Blue Cross…I could go on.  

This new 1099 reporting is intended to capture currently unreported income to generate more government revenue and help offset the cost of reform. It’s been defended as an alternative to raising taxes on small business and is seen to be a fair trade for $35 billion in tax credits small businesses get under reform. It’s an attempt to collect the nearly $300 billion of income that the IRS says goes unreported.

I have three problems with that:

• First, my business won’t see any of that tax credit benefit, 
• Second, my business will incur additional costs, not only in staff time for obtaining tax IDs from every vendor, but also in accountant fees for processing and mailing the forms, and
• Third, my business is being required to help the IRS monitor tax reporting compliance of other businesses.

At this point, we estimate the number of 1099s we will file will increase to 1,000. I’m not sure how a small firm like mine is going to find its way through the mazes of large companies to get the information, but I’m angry that this law – touted as having so many ‘upsides’ – provides none for my firm but asks us to carry an additional burden that drives up the cost of doing business.

I can live without the ‘upsides.’ I’ve provided insurance and promoted wellness all along and will continue to do so.

But now, I’ve been mandated to become a de facto agent of IRS enforcement. Surely, the IRS has better tools for finding unreported income than asking small firms like mine to do it for them.

Related posts:

1. You Gotta Laugh: Life in the Trenches of the Health Insurance Business
2. Life in the Trenches of the Health Insurance Business
3. The NHMA Forum on Health Care Reform offers an opportunity to impact health reform legislation

Source: dw@disruptivewomen.net

According to a recent study by Pollack and Lynch (2009), having your house foreclosed is bad for your health.  The Penn Gazette summarizes the paper’s findings as follows:

“[the authors]  presented sobering findings culled from a survey of 250 Philadelphians who had sought credit counseling for home mortgage foreclosure.  More than one-third of the study participants met screening criteria for major depression, and after adjusting for demographic and financial factors, people undergoing foreclosure had significantly higher rates of hypertension and heart disease than others in the community.”

• Pollack CE and Lynch J (2009) “Health Status of People Undergoing Foreclosure in the Philadelphia Region,” American Journal of Public Health, Vol 99, No. 10: 1833-1839.

Source: Jason Shafrin