Medicaid Work Requirements Would Impact Older Adults who are “determined by the state to be medically frail” and people with “acute medical conditions validated by a medical professional that would prevent The Commonwealth Fund them from complying with the recently released requirements” of a work a report analyzing different demonstration. CMS also notes proposals by states to impose a that federal law may require work requirement for Medicaid states to modify work benefits and how those requirements to reasonably proposals would impact older accommodate qualified adults and people with individuals with disabilities. disabilities. To date, 12 states However, the guidance does have proposed conducting not include any expectation to demonstrations that add work exempt older adults from work requirements to Medicaid, and requirements. The the Centers for Medicare & Commonwealth Fund argues Medicaid Services (CMS) has so that “[a]ge exemption from work far approved proposals from requirements should be carefully Kentucky, Indiana, and considered given that lowArkansas. Among other policy income working-age adults are changes, these demonstrations significantly more likely than would tie Medicaid benefits to a those with higher incomes to minimum work requirement. report being in fair or poor In policy guidance on work health or having at least one of requirements released in five chronic conditions, January, CMS stated that it including hypertension, heart expects states to exempt people disease, diabetes, asthma, or
high cholesterol. And risk increases with age. By age 50, 70 percent of people below 200 percent of the federal poverty level report fair to poor health or having one or more chronic conditions; this percentage climbs to 83 percent by age 55.” Approaches vary among the proposals submitted so far. Three states have proposed to eliminate the work mandate for people age 50 and older. Other states maintain the requirements to age 65, but point to the “medical frailty” exemption to allow them to make case-bycase determinations. In its guidance, CMS defines the term “medically frail” only in broad terms, and does not distinguish from the existing definition in other federal regulations that identify expansion Medicaid beneficiaries who are entitled to Original Medicaid rather than a more limited package of benefits that a state might offer to the broader expansion population.
Under that definition, the overwhelming majority of older poor adults could be designated as medically frail. To date, four states — Maine, Mississippi, Utah, and Wisconsin — indicate that they intend to use a definition of medically frail that restricts the designation to people who cannot work at all—a standard that mirrors eligibility for Social Security Disability Insurance. Whether CMS will permit such an extreme variation on the current standard, remains to be seen. The Commonwealth Fund calls upon CMS to more clearly define the acceptable limits of these work requirements, and to reduce the administrative burden on states and beneficiaries, as well as the stress and risk to beneficiary’s health, by requiring that states categorically exempt at least some older adults. Read the report.
Staying Alive: How To Fight An Opioid Addiction Rule No. 1: Stay alive. If you or a loved one wants to beat an opioid addiction, first make sure you have a handy supply of naloxone, a medication that can reverse an overdose and save your life. “Friends and families need to keep naloxone with them,” says Dr. David Kan, an addiction medicine specialist in Walnut Creek who is president of the California Society of Addiction Medicine. “People using opioids should keep it with them, too.” More than 42,200 Americans died from opioid overdoses in 2016, victims of a crisis that’s being fueled by the rise of a powerful synthetic opioid called fentanyl, which is 30 to 50 times more potent than heroin. Rock stars Princeand Tom Petty had
fentanyl in their systems when they died. People can become addicted to opioids through long-term use, or misuse, of prescription painkillers. In most cases, that leads to heroin use, according to the National Institute on Drug Abuse. If you’re ready to address your own addiction, or that of a loved one, know that you may not succeed — at first. You probably won’t be able to do it without outside help or medications. And you’ll probably have to take those medications for years — or the rest of your life. “Getting over a drug addiction is a process. There are going to be ups and downs,” says Patt Denning, director of clinical services and training at the Center for Harm
Reduction Therapy in San Francisco and Oakland. “We need to hang with people while they’re struggling. It might take awhile.” That’s why Denning and others suggest you start with having naloxone on hand, which can help you stay alive through the process. Last year in San Francisco, about 1,200 potentially fatal overdoses were reversed by regular folks administering naloxone, not doctors, police or paramedics, Kan says. Naloxone, which can be administered as a nasal spray or injection, is available without a prescription in more than 40 states, including Califor nia. Ask your pharmacy if it stocks the drug. Needle exchange programs also offer the medication at no charge,
Denning says, as do some public health clinics. Rehab Alone Doesn’t Work People addicted to opioids face staggering relapse rates of 80 to 90 percent within 90 days if they try shortterm rehab or detox programs that wean them off the drugs without assistance from medications, says Richard Rawson, a UCLA psychiatry professor emeritus. Rawson warns that rehab can also increase the risk of an overdose, because your body’s tolerance to opioids is lower after you withdraw from them….Read More
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