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Karen Palacios, age 42, suffers from multiple chronic conditions, including diabetes, a thyroid condition, effects of a stroke, and depression. Karen has both Medicare and Medicaid due to her disability and low-income. For seven years, she lived in a nursing home because she could no longer perform basic everyday activities on her own. However, through Medicaid’s “Money Follows the Person” (MFP) initiative, Karen was able to make the transition back to living independently in the community. While Medicare covers most medical care that Karen needs, the MFP program provided Karen with access to crucial transition services, like occupational therapy to gain skills she needed to live alone, and help arranging for housing. Medicaid also covers a personal care aide, medical transportation, and other supports that Medicare does not cover but that Karen needs to function independently.
Nearly 9 million low-income Americans known as “dual eligibles” qualify for both Medicare and Medicaid. Medicaid plays a key role for dual eligibles, covering their Medicare premium and cost-sharing, and filling major gaps in Medicare benefits, especially for long-term care, but also for items like eyeglasses and hearing aids, needed by many in the Medicare population. About six in ten dual eligibles are age 65 or older, while the others are younger persons with disabilities, like Karen. Dual eligibles account for just 15% of Medicaid enrollees but almost 40% of Medicaid spending, a reflection of their extensive needs for acute health care and long-term services and supports. Dual eligibles must navigate both Medicare and Medicaid to access the care they need. The health reform law establishes a new federal office focused on improving the coordination of care for dual eligibles.
I am highly satisfied with Medicaid and Home Choice; they are there if I need anything.