Medicare is a federal
government-funded insurance program that is available to most Americans once
they reach the age of 65, regardless of their income. Medicare covers hospital
bills, medical insurance and prescriptions. Although Medicare is the main provider
of medical care for the elderly and disabled, it does not cover all medical
costs (De Nardi, French, Jones, & Gooptu, 2012). Medicaid is a
supplemental, federal and state government-funded form of insurance available
to qualifying, low-income individuals. Medicaid is also available to
middle-income individuals with high medical expenses. Medicaid coverage varies
from state to state, and not all mental illnesses are covered due to higher
medical costs. I believe that if Medicaid and Medicare were collectively both
government regulated, individuals with mental disorders may receive better
health care and treatment benefits. In addition to providing better health
care, the combined regulation would also reduce federal spending for health
care.
Medicaid is
available to anyone who has high medical expenses that they are unable to
manage, regardless of age. But the elderly are the largest group to receive
financial support for medical expenses through Medicaid. Medicaid now assists
70 percent of nursing home residents and helps the elderly poor pay for other
medical expenses as well (De Nardi, French, Jones, & Gooptu, 2012).
Medicaid is often used as a supplemental form of health insurance for those
over the age of 65 in conjunction with Medicare. These seniors are termed
“duals”. They are lower income (more than 50 percent have income below poverty
level), sicker (41 percent are disabled and 20 percent report poor health
status), more likely to be institutionalized (19 percent), and bear more
chronic conditions (29 percent have three or more chronic conditions compared
to 10 percent for non-duals) than non-dual elderly Medicare beneficiaries
(Frank, 2013). Mental disorders among the elderly are becoming more prevalent,
which is another costly aspect for Medicaid.
A large part
of Medicaid is helping those with mental disorders, and many elderly people
have both mental disorders and other sicknesses. Among these elderly
individuals receiving Medicaid benefits, older adults uniformly have higher
spending levels across all mental health conditions, with about 62 percent of
spending in the older-than-age-65 group going to people with mental disorders,
largely anxiety (Frank, 2013). A beneficiary is reported having a mental
disorder if they had a claim with a primary diagnosis for services for mental
illness care, use a psychotropic drug, or are treated under a specialty mental
health procedure code during that year (Frank, 2013). Annual money that goes to
those with mental disorders is a necessity but the cost on Medicaid is so
drastic and continues to put a strain on funding so that in the future there
won’t be enough funds to help out everyone who needs it.
Another key
importance is those who have mental issues usually go untreated because many
individuals think it’s a normal aging process. Yet, it is estimated that almost half of older adults
with a recognized mental health disorder do not seek or receive mental health
services (Bartels et al., 2002). It would be beneficial for the elderly to
understand the effects of aging and to seek medical services when needed. Many
older adults know little about depression and believe it is “normal” for people
to get depressed as they grow older (U.S. DHHS, 1999). If individuals aren’t
receiving the proper healthcare, especially for mental illnesses, then every
year their brain health is steadily going to decrease. Yet, it is estimated
that almost half of older adults with a recognized mental health disorder do
not seek or receive mental health services (Bartels et al., 2002).
The total
yearly cost of Medicaid has increased steadily for both the federal and state
governments. The share of total federal, state, and local government
expenditure absorbed by Medicaid rose from less than 2 percent in 1970 to
almost 7 percent in 2009, and it is expected to increase even more in the
future (De Nardi, French, Jones, Gooptu, 2013). With Medicaid taking so much of
the federal and state budgets, Medicaid may be unavailable or terminated in the
future due to budget cuts. In 2009, Medicaid spent over 75 billion on 5.3
million elderly beneficiaries (De Nardi, French, Jones, Gooptu, 2013). If these
numbers continue to rise then eventually the government won’t be able to help
those who need medical assistance. Also, those with mental illnesses might not
get the needed help in order to function in everyday life, so it’s crucial the
government mandates how the money is being spent.
In addition
to Medicare and Medicaid, senior citizens would benefit from peer provided
mental health support. The mental health literature and
government programs such as Medicaid support the use of peer interventions for
adults with mental health diagnoses, including severe mental illness (e.g.,
Bazelon Center for Mental Health Law, 2003; Solomon, 2004). Peer provided support
may educate seniors about possible mental illnesses and symptoms, treatments
available, and reduce the stigma associated with these mental illnesses. Many
seniors feel more comfortable discussing their issues with peers than their
physicians. Additionally, peer support provides social interactions that can
help decrease the symptoms or onset of mental illnesses such as depression or
anxiety. In conjunction
with peer provided mental health support, elderly persons suffering from mental
illnesses would benefit from having aging specialist on staff at mental care
facilities. However, scarcity of trained geriatric professionals makes it
difficult to recruit aging specialists (Chapin et al., 2013).
Medicaid
would benefit from helping senior citizens become aware of the different types
of mental illnesses that are common and their symptoms. Research has also shown
that reducing mental illness can improve older adults’ physical health (Ormel
et al., 1993). So by educating and assisting seniors receiving both Medicaid
and Medicare benefits, not only could mental illnesses be better treated but
the overall spending for both could go down. The more we educate and find other
alternatives for treating individuals with mental illnesses, the less likely we
are to spend government funding.
I feel that
we need to better regulate Medicare and Medicaid. With both Medicare and
Medicaid being funded by the federal government, and Medicaid being designed as
a supplemental insurance to Medicare, low-income elderly individuals would
receive better healthcare options and treatment. Additionally, if Medicaid
offered programs that are specifically designed to help those with mental
illnesses, including offering peer support and aging specialists, many senior
citizens would be more likely to understand their mental illness. I believe
that it is necessary to provide the low-income senior citizens with the proper
healthcare and options, especially to those with mental illnesses. If there are
no changes made to the Medicare and Medicaid programs, neither may be available
in the future due to high costs and a limited federal budget.
REFERENCES
Chapin, R. K., Sergeant, J. F., Landry, S., Leedahl, S. N.,
Rachlin, R., Koenig, T., &
Graham, A. (2013). Reclaiming Joy:
Pilot Evaluation of a Mental Health Peer Support Program for Older Adults Who
Receive Medicaid. Gerontologist, 53(2), 345-352. doi:10.1093/geront/gns120
De Nardi, M., French, E., Jones, J. B., & Gooptu, A.
(2012). Medicaid and the elderly.
Economic
Perspectives, (1), 17-34.
Frank, R. G. (2013). Mental Illness and a Duals Dilemma.
Generations, 37(2), 47-53.
Bartels, S. J., Dums, A. R., Oxman, T. E., Schneider, L. S.,
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S., & Jeste, D. V. (2002).
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of the surgeon general. Rockville,
MD: Substance Abuse and Mental Health Services Administration, National
Institutes of Mental Health, National Institute of Health.
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Bazelon Center for
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Medicaid. Washington, DC: Bazelon
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Solomon, P. (2004).
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