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Today, a Medicare Rights Center client, Jane Doyle, testified before the U.S. Senate Special Committee on Aging about her and her family’s experiences with Medicare and Medicaid. In the hearing, titled “Improving Care Experiences for People with both Medicare and Medicaid,” she shared her perspective as someone dually eligible for both programs, and as a caregiver for her mother, who also has Medicare and Medicaid.
She explained that while the programs are important, they are not always easy to use. She recounted how she would often struggle to find providers who not only accepted Medicaid, but also understood and were willing to undertake the complex billing and administrative processes needed to obtain payment for providing her care. Ms. Doyle described her concerns that people who don’t have the established relationships with providers she was fortunate enough to have, including with providers who are willing to forgo some of their payment, may not be able to access needed care. She also expressed her worry that “since many doctors don’t take the managed care, and these programs try to cut costs, the quality of care I receive suffers.” As an example, she noted that during the pandemic, she had three operations, one of which resulted in irreversible nerve damage. “This resulted in me needing neurosurgery, and I had to travel 100 miles to Philadelphia to get that care.”
She also talked about her mother’s interactions with Medicare and Medicaid, including her eligibility and access challenges. Her mother participates in a waiver program, which provides Medicaid coverage for Home- and Community-Based Long Term Care Services and Supports (LTCSS). Accessing these services in her home, instead of having to move to a nursing home, was her preference, and Ms. Doyle and her family wanted to honor that. Unfortunately, the process to get into that program was onerous and stressful. It involved nearly depleting her mother’s assets, filing often overwhelming amounts of paperwork, identifying and coordinating with a provider willing to oversee the case, and finding a participating home health care agency able to meet her mother’s needs. As she told the Committee, “We had to complete hundreds of documents for my mother’s application. Eventually, we didn’t have enough money to pay for one more day of care.”
Finally, Ms. Doyle talked about her frustration and worry that she would not be able to purchase a supplemental Medigap plan to provide coverage for her out-of-pocket expenses if she were to lose Medicaid. Because she had Medicaid when she was first eligible for Medicare, she is, in a way, “trapped” in Medicaid – she cannot increase her income or savings for fear of losing Medicaid’s important protection against unlimited out-of-pocket costs. Ms. Doyle asked the Committee to continue to pay attention to the needs of people who have Medicare and Medicaid, and to pass laws that will make accessing care and coverage less onerous and less precarious for people like herself and her mother. “To make these programs actually work, it needs to be much easier for people like my mother to enroll and for people like me to find care,” she said.
Medicare Rights is grateful to Ms. Doyle for testifying before the Committee. We will strive to honor her and her family’s experience by advocating for policy changes that strengthen and simplify Medicare and Medicaid.
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