As Florida "unwinds" from the COVID-19 public health emergency and returns its Medicaid program to pre-pandemic rules, there's a possibility that older people - in addition to children - could lose their coverage even if they're still eligible.

Senior advocates are calling attention to Florida's "MEDS AD" program - or Medicaid for people who are older or have disabilities - and those receiving home and community-based services through a managed-care company, enrolled in what's called Long Term Care.

Miriam Harmatz, advocacy director and founder of the Florida Health Justice Project, said she's concerned that people who've not had to renew any of their eligibility paperwork since 2020 will be lost or confused when they receive notices in the mail.

"People have fallen through the cracks in the past, even though they're eligible," said Harmatz, "whether that's because they failed to get in verification as required, or it gets lost or there's a computer SNAFU. All of those things happen."

The DeSantis administration says it will return the Medicaid program to its pre-pandemic operations beginning April 1. That includes removing about 900,000 people the state says are no longer eligible, and who haven't used Medicaid-covered services.

Harmatz has been trying to get the word out, hosting Q&A sessions on her website for anyone whose coverage might be affected based on age or disability.

Harmatz said she's calling for more support for these groups, urging friends and families to assist them with navigating the termination notices in their mail to ensure they can properly reapply.

"And so it's critical that this population be getting special attention to insure every single one of them, because they are so vulnerable," said Harmatz. "Imagine if you've been getting these services and they just stop, especially if you're living alone."

The state says it will also begin efforts to re-determine Medicaid eligibility for another 850,000 Floridians who haven't provided their financial information during the pandemic.

Harmatz encouraged people to make sure their contact information is up-to-date on the Department of Children and Families website and be on the lookout for notices in the mail.



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Families of rural Iowans with Alzheimer's disease and other forms of dementia face a crucial lack of mental health services and advocates are meeting with some rural residents today to assess their most important needs.

Iowa has only 26 geriatricians practicing in the state. The Alzheimer's Association said the state needs at least four times as many to meet the growing demand by 2050, and 32% more direct care workers for dementia patients by 2030.

Lauren Livingston, communications director for the Iowa chapter of the Alzheimer's Association, said the current provider shortage falls most heavily on rural Iowa, which has been declared a dementia care "desert."

"Most rural communities are unfortunately not lucky enough to have even a neurologist that is specialized in Alzheimer's disease and can help diagnose," Livingston pointed out. "Even with that first step of diagnosis, there isn't anywhere to even get a referral to a doctor who would know how to diagnose it or what the next steps were."

The Alzheimer's Association said 11% of Iowans age 65 and older are living with the disease. Today's online forum is designed to hear from affected rural residents about their most pressing concerns.

Livingston noted they hope to get good information from rural health care providers, families and caregivers about the types of support services missing in their communities.

"Then from there, we want to be able to put together more of a plan of how we can help in these rural communities and close that gap," Livingston emphasized.

Roughly 62,000 Iowans live with Alzheimer's disease, and another 100,000 are unpaid family caregivers. AARP Iowa is pushing for a measure in the state legislature to offer them a tax credit to help offset their out-of-pocket care expenses.


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What is the quality of Virginia's nursing homes? If you ask one advocate, he says "bad."

Jared Calfee, state advocacy director for AARP Virginia, said nursing home inspectors are "woefully" behind.

A possible legislative fix is a bill that would update what Calfee called the outdated fee structure for medical facilities.

The Virginia Department of Health would use those extra funds to increase recruitment and retention of inspectors. Calfee added understaffing can lead to worsening health for nursing home residents.

"What we know is that understaffing leads to negative outcomes, like pressure sores, falls, and ultimately sickness, and even death in a lot of cases," said Calfee. "And so the best thing that we can do for nursing home residents is ensure that there is adequate staff to provide quality care in our facilities."

The Virginia Joint Legislative Audit and Review Commission finds that nearly 40% of nursing homes are in need of their biennial state licensing inspection.

And the Commonwealth has the sixth highest proportion of nursing homes that have not been inspected within two years.

Another budget proposal would include $3.5 million to train Virginians as certified nurse aides, or CNAs.

CNAs provide the bulk of assistance within nursing facilities. Calfee said this small budget ask could have big impacts for nursing home staff.

"This is a high-demand area where we badly need staff," said Calfee, "so a program like this could take a relatively small amount of money, and hopefully infuse the workforce with badly needed staff - to make sure that our nursing homes can staff adequately."

A Virginia Health Care Association survey in 2022 found that 93% of facilities in the Commonwealth have openings for CNAs.

A number of bills in the Maryland legislature are looking to increase the quality and accountability of the state's nursing homes and assisted living facilities.

Advocates for seniors are supporting a bill that would require facilities to install video surveillance systems in common areas.

That way, there would be video evidence to monitor any neglect, abuse or exploitation of residents.
Another bill would increase the number of inspections of assisted living facilities.

Tammy Bresnahan the senior director of advocacy for AARP Maryland.

She said a lot of her focus this legislative session is on assisted living facilities, because of how many high-care individuals they take in.

"We've been looking at assisted living, because they're systematically taking more chronically health-needed individuals," said Bresnahan. "So they look a lot like what's in a nursing home, but people are privately paid for that."

Bresnahan explained that nursing homes have many layers of accountability, given the state and federal medicare dollars flowing into the facilities.

Assisted living centers, on the other hand, usually only receive funds from private customers - with little oversight.

Data from the Center for Medicare and Medicaid Services found Maryland has some of the longest wait times for nursing home inspections, at nearly three years.

Bresnahan added that it's important to have more inspections for assisted living facilities.

"The regulations really only require initially for the licensure to have the inspection - and if there's a problem, they have to go out," said Bresnahan. "So, they really want their assisted living to be inspected more often. "

Bresnahan said any Maryland senior considering a nursing home or assisted living facility should call the Maryland Office of Healthcare Quality.

That office can let seniors know if a facility has a history of issues.