Low-income elderly and disabled Americans are among the most vulnerable patients within the health care system. With specialized medical needs and limited income, this population, identified as the Aged, Blind, and Disabled (ABD) under Medicaid’s enrollment criteria, rose to nearly 14.8 million in 2013 according to the Kaiser Foundation.
A jointly funded, Federal-State health insurance program for low-income and needy people, Medicaid provides health coverage for seniors and people with disabilities whose incomes exceed the limit for Supplemental Security Income (SSI) but are still below the federal poverty level. Medicaid can play an important role in access to care for disadvantaged populations, including providing long-term care and covering a variety of supportive services so important to the chronically ill and disabled. Even with assistance, resources for basic needs often run short for ABD members. So, how can we better serve this high needs population?
Medicaid, SSI, and the Aged, Blind, and Disabled (ABD)
While the Medicaid program helps millions of low-income elderly and disabled people, keeping pace with the health care requirements of America’s aging population remains an ongoing challenge. In April 2016, the Medicaid and CHIP Managed Care Final Rule was released – the first major change to the Medicaid managed care program in over a decade. The changes are especially relevant to the ABD population, who experience chronic health issues and for whom challenges like enrollment, coordination of care, and access to quality care are especially important.
The new income rules of the transitioning Medicaid system are significant for ABD members, with new income limits varying depending upon whether individuals need long-term care, which is frequently the case, or not. For both those with long-term needs and without, the Medicaid gross income limits for the ABD program rose under the new ruling, to $733 per month for those without long-term needs, and $2,199 per month for those with long-term needs. These amounts are federally mandated across all states using Medicaid.
Supplemental Security Income (SSI) is the main source of monthly income for elderly and disabled individuals. SSI is a Federal income supplement program funded by general tax revenues. According to the Social Security Administration, SSI is designed to help aged, blind, and disabled people, who have little or no income, by providing cash to meet basic needs for food, clothing, and shelter.
Take Kira, for example. A 34-year-old from North Carolina, Kira lives with Cerebral Palsy. The $400 per month she earns from her job is not enough to keep up with her basic needs or ease the challenges of coping with the daily struggles caused by her debilitating condition. SSI and Medicaid help her bridge the gap. "Social Security Disability Insurance benefits allow me to have the quality of life afforded to every human being," she says. The transforming ABD program helps people like Kira maintain basic needs so that they can focus on staying healthy.
Progress through Innovation
As Medicaid continues to transform the way it serves ABD individuals, the Centers for Medicare and Medicaid Services (CMS) pledge to tackle tough issues on multiple fronts. According to Andy Slavitt, CMS Acting Administrator, and Vikki Wachino, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services, technology will be a key tool for driving the innovation needed for progress.
Slavitt says that work is already underway to update legacy IT systems and deploy tools that improve coordination of patient care. And advanced technologies like analytics are helping the Medicaid managed care policy and program administration.
In an industry perspective, Government Technology outlined how analytics-driven policy can improve health care for the ABD population by using data to identify trends that can inform health care policy. North Carolina used analytics in a health improvement initiative for its ABD Medicaid population. Applying analytics to data for patients with multiple chronic conditions improved the coordination of care for ABD patients. Several benefits resulted, including a 10% reduction in emergency department visits and a 4 percent reduction in inpatient admissions among ABD individuals. The analytics initiative also reduced preventable re-admissions by 34 percent among ABD patients.
As America’s health care landscape continues to evolve alongside this country’s aging population, Medicaid’s role in helping the aged, blind, and disabled members of our communities will likely continue to expand, striving to keep them healthier for longer periods of time. Improving coordination of, and access to, quality care for this vulnerable population requires ongoing innovation in policy, planning, and technology to improve outcomes while keeping costs in check.
 Social Security Administration, What is Medicaid?
 Government Technology, 5 pieces of Advice about Analytics and the New Medicaid Rules, June 2016