Octubre es el Mes de la Planificación de los Cuidados a Largo Plazo, y algunos consejos pueden ayudar a las personas a comprender por dónde empezar a la hora de pensar en el futuro.

El costo de los cuidados es uno de los aspectos más importantes de la planificación.

Bea Rector trabaja en la Administración de Apoyo a Largo Plazo del Departamento de Servicios Sociales y Sanitarios del Estado de Washington. Dice que la gente normalmente no puede confiar en el seguro médico para cubrir estos costos.

"Si alguien no tiene un seguro de atención a largo plazo," dice Rector, "tiene que recurrir a familiares y amigos para que le ayuden a cuidar de él, o comprar los servicios de su bolsillo, o, por supuesto, está el programa de seguridad que es Medicaid."

Rector afirma que la atención domiciliaria o estar en un centro fuera del hogar puede resultar costoso. Señala que muchas personas reciben atención de un ser querido, lo que puede reducir los costos, pero también supone una carga para la persona que la brinda.

Según Rector, Washington es el único Estado del país que cuenta con un programa al que contribuyen los trabajadores para financiar los cuidados de larga duración.

WA Cares Fund dará acceso a prestaciones de hasta $36,500 dólares a partir de 2026. La cantidad se ajustará a la inflación en el futuro.

Rector dice que el dinero es flexible.

"Se puede utilizar para pagar una gran variedad de cosas, desde modificaciones en el hogar hasta rampas para sillas de ruedas, servicios de atención personal en el hogar o incluso servicios fuera del hogar, como en un hogar familiar para adultos o en un centro de vida asistida."

Rector dice que es esencial empezar a planificar con tiempo.

"Asegurarse de que los seres queridos que te rodean sepan cómo quieres que eso sea," dice Rector, "y de que cuentas con apoyos para la toma de decisiones, como poderes notariales duraderos, etc., para que las decisiones financieras o medicas sean tomadas por alguien de tu confianza. "



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A coalition of Montana groups will rally at the Capitol Wednesday to advocate for the protection of Medicaid expansion, which legislators will debate this session before the program's scheduled expiration in June.

The state's 10-year-old Medicaid expansion program covers 75,000 low-income Montanans at an annual cost of about $1 billion, according to KFF Health News. The state picks up about 10% of the tab.

Kristen Stewart of Billings is a caregiver for her 90-year-old grandmother, and enrolled in Medicaid herself. As an organizer with the advocacy group Big Sky 55+, she noted many Medicaid enrollees work but the work is often undervalued.

"Medicaid supports a lot of people who are doing unpaid work," Stewart pointed out. "Things that were we to monetize, you would see an economic boost from their production level, often more than the cost of their care."

The Gianforte administration already tightened eligibility for the program, cutting the number of enrollees by nearly 40% between May 2023 and October 2024. The program currently covers nondisabled adults ages 19 to 64 who make less than $21,000 a year.

Jeannie Brown, a bus driver for the Belgrade Public School District and a full-time caregiver and legal guardian for her teenage granddaughter, said if Medicaid expansion does not get reauthorized, she will be on a "slippery slope."

"Because I'm 60 years old and I'm having my own health issues after being a caregiver, it's hard work and it takes a toll on you physically, financially and emotionally," Brown explained. "I'm hoping these legislators really take all of these things into consideration and reauthorize it."

Any laws passed on the issue could also affect the state's behavioral health services, which Gov. Greg Gianforte has made a priority.

Obtaining medical records can be a costly endeavor but there is hope Washington state lawmakers could find a fix this session.

Medical providers look for compensation when producing medical records because of the work involved in the process.

Holly Brauchli, an attorney at Seattle Injury Law, said an outdated process is used to determine the cost. Federal law requires all records to be digitized and Brauchli pointed out providers charge per page as if the records were on paper.

"We download it and we get a bill for thousands of dollars and the justification of that bill is that there's a per page charge," Brauchli explained. "I get these invoices that say copying charge per page. There are no copies."

Brauchli noted there are a variety of reasons why someone would want to obtain their medical records. For instance, the records could be important to an injury lawsuit or someone might want to check if their health insurance was billing them correctly.

Brauchli argued records should no longer be charged as if they are on paper.

"This seems like a really easy fix and certainly one that would help Washington citizens," Brauchli contended. "People have a right to know what's in their medical record and they have a right to be able to see it. So, to me, it's a really simple and elegant fix."

A bill has not been filed yet but is expected from Sen. Tina Orwall, D-Des Moines, soon. The 2025 legislative session starts today.

This Wednesday is the deadline to enroll in Affordable Care Act marketplace health coverage.

Advocates say this year is even more critical for those seeking a plan, because the expanded tax credits that allowed many Kentuckians to enroll in health coverage - at little or no monthly cost - are set to expire at the end of this year.

After Jan. 15, folks will have to qualify for a special enrollment period to take advantage of Advanced Premium Tax Credits while they still exist.

Priscilla Easterling, director of outreach and enrollment with Kentucky Voices for Health, said the state's uninsured rate could potentially increase if families can't afford coverage without the credits.

"I think we should all be very concerned," said Easterling. "Without these enhanced premium tax credits being extended, we're going to see enrollment drop off, because families will no longer be able to afford that monthly premium."

According to research from the Robert Wood Johnson Foundation, the elimination of expanded tax credits would especially impact older adults - who tend to have higher health coverage costs.

In 2024, people over age 50 made up more than one-third of total ACA enrollment.

Easterling said in many cases, for low-income individuals making around $22,000 per year, the credits covered the full cost of their plan, and have saved Kentuckians thousands of dollars a year.

"They have been around for the duration of the ACA," said Easterling, "but the enhanced part that was first expanded in 2021. They have, on average, saved most households over $500 per month."

Easterling said residents can find local experts at kynect.gov to help them take advantage of tax credits and find the best plan for them.

"There are 'kynectors' available in all 120 counties," said Easterling, "who can help and provide free assistance for anyone who needs help navigating Kynect.gov or trying to get enrolled in coverage."

During 2024, more than 71,000 Kentucky residents enrolled in a plan through the marketplace, according to the health advocacy group KFF.

Nationwide, a record 24 million people have signed up for insurance coverage through the Affordable Care Act, according to federal data.