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Medi-cal changes for California seniors

Medi-Cal Changes for California Seniors

New and expanded Medi-Cal eligiblity criteria in 2022 will allow more people to access Medi-Cal coverage. Medi-Cal changes for California seniors offer many a new chance to qualify for Medi-Cal. Read on to learn more about these changes, which for some seniors could include becoming eligible for WelbeHealth or other PACE programs in your area.

For more detailed information, see the resources listed at the bottom of the article.

  • Expanded Coverage for Undocumented Seniors
    Beginning in May 2022, Medi-Cal benefits will be provided to all individuals over the age of 50 who meet financial eligibility requirements, regardless of immigration status. This includes primary, specialty, behavioral health, long-term care, and much more. Those not currently enrolled in restricted scope Medi-Cal will need to apply to find out if they meet eligibility requirements.
  • Increased Asset Limits
    In July of 2022, the asset limit will increase for many Medi-Cal programs from $2,000 to $130,000 for individuals (plus $65,000 for each additional family member). Once this change is in effect, DHCS will send letters to those who were denied Medi-Cal or terminated coverage for being over the asset limit during the 90 days before the effective date of the change.

How this may affect you: If you were previously denied Medi-Cal enrollment due to immigration status or assets, you may want to consider re-applying.

 

Changes to Medi-Cal Managed Care in 2022 and 2023

The California Advancing and Innovating Medi-Cal (CalAIM) initiative standardizes managed care enrollment and benefits, addresses social determinants of health, and reduces inequities. As part of the CalAIM initiative, some health coverage changes will impact Medi-Cal enrollees across all of California. Other changes only impact certain populations or enrollees in certain counties.

How this may affect you: The way you receive Medi-Cal benefits through your managed care plan may be changing, including the health plan you are enrolled in or the services available through your current Medi-Cal managed care plan.

  • Changes for Dual-eligible, Medi-Cal and Medicare Individuals
    Starting January 2023, dual-eligible individuals will be required to enroll in a Medi-Cal managed care plan. If you are eligible for both Medicare and Medi-Cal, you will receive enrollment forms to choose the plan you want to enroll in. PACE programs such as WelbeHealth will be listed as an option on these enrollment forms. This is a great time to consider participating in WelbeHealth’s PACE services if you are eligible and live in one of our service areas.
  • Changes for those with a Medi-Cal share of cost
    As part of CalAIM, some Medi-Cal beneficiaries* with a share of cost are moving out of managed care, into fee-for-service Medi-Cal. If you have been on a Medi-Cal plan that has a share of cost, you will automatically be enrolled in fee-for-service Medi-Cal unless you live in a long-term care facility. This change affects those enrolled in both Medi-Cal and Medicare and those enrolled in Medi-Cal only.If you were previously enrolled in a Cal MediConnect plan, you will be disenrolled from Cal MediConnect. You will need to select a new Part D prescription plan to cover prescription drugs.Note that under fee-for-service Medi-Cal, there may be some changes to how transportation is made available to you. DHCS’s Transportation Services web page provides instructions on how you can get transportation under fee-for-service.
  • Managed Care Enrollment for Certain Populations
    Certain population groups who are required to enroll in a Medi-Cal managed care plan are expanding statewide. If you are part of one of these special groups, you would have received two notices in the Fall of 2021. You can make a managed care selection or be added to a state-selected managed care plan.
  • End of MediConnect Plans in December
    As of December 31, 2022, if you are enrolled in a Cal MediConnect plan, you will automatically move to a dual special needs plans operated by the parent organization of your Cal MediConnect plan. If you have questions or would like to select a different health plan (including PACE), contact the Health Consumer Alliance (HCA) at 1-888-804-3536. The HCA can assist Californians who are trying to get or keep their health coverage.

 

Could you now be eligible for PACE?

WelbeHealth’s PACE provides all-inclusive coordinated care. Visit welbehealth.com for information about our services.

You may have questions about these Medi-Cal changes for California seniors. At WelbeHealth we have experts available to assist you in evaluating whether you qualify for Medi-Cal. Call us at (888) 530-4415, TTY (800) 735-2922 to learn more.

 

References and Resources:

*Some changes only affect individuals residing in a CCI county (Los Angeles, San Bernadino, Riverside, Orange County, San Diego, Santa Clara, and San Mateo) or a COHS county (Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, and Yolo).

Nurse coordinator

Care Coordination for Seniors

Seniors with complex medical conditions often need help managing their care. They see multiple doctors and specialists. They’re taking multiple medications, have several medical appointments a month, and may need assistance in their home. Professional care coordination for seniors can help manage a senior’s health care.

Research shows that 35 percent of those over age 65 have no one assisting them with coordinating their care. Thirty-four percent say a family member coordinates their care.

Care coordination can be beneficial for seniors and caregivers, especially for the 85 percent of older adults who live with one or more complex medical conditions.

What is care coordination?

Seniors, or their spouse or adult child, often do the work of coordinating their care. They make appointments, provide transportation, communicate with physicians, and assist in the home.

Professional care coordination for seniors is more in-depth and comprehensive. It involves multiple medical experts who specialize in the health of the elderly. The team helps the senior meet their medical needs, provides the needed resources, and updates the care team. Care coordination is personalized and uses the input of the patient and caregiver.

The benefits of care coordination for seniors and their families

  • Doctors stay informed. Living with a complex medical condition often means having more than one doctor who provides your care. One goal of care coordination is to keep all healthcare providers informed. This saves the patient from redundant testing, screening, and treatment. Changes in medication, new or worsening symptoms, and changes in medical history are all topics to be shared among your team of physicians.
  • Better healthcare outcomes. Studies have shown that professional care coordination results in better health outcomes. Patients are often more satisfied with the quality of care because it is personalized and streamlined.
  • Social and emotional needs met. Care coordination focuses on the patient’s physical, social and emotional health. Healthcare professionals connect the patient to resources such as counseling and support groups and promote wellness of the mind.
  • Relief for caregivers. Family members often take on coordinating care for their aging loved one. As their loved one’s condition grows more complex, it can be a lot to manage. Professional care coordination for seniors relieves caregivers of doing this, while keeping them informed. Therefore, they have more time to work, rest, or tend to their own health needs.

WelbeHealth provides care coordination for seniors with complex medical conditions.

WelbeHealth’s program of all-inclusive care for the elderly (PACE)  provides professional coordinated care to seniors.

Interdisciplinary Team

At the heart of WelbeHealth’s PACE is the interdisciplinary team. This team stays current on each senior in their care, and adjusts care as needed. Each team member specializes in caring for seniors with complex medical conditions. The team includes specialists such as:

  • Primary care physician
  • Nurse
  • Physical therapist
  • Occupational therapist
  • Recreation therapist
  • Dietician
  • Social worker
  • Home care coordinator
  • Transportation professional

Day Center

WelbeHealth’s day centers make providing coordinated care seamless. In the day center, seniors can get many physical needs met and socialize with other participants. Under one roof, participants can receive:

  • Primary care
  • Dental, vision, and hearing care
  • Physical and occupational therapy
  • Recreational therapy
  • Nutritious meals and socializing with other seniors and staff
  • Exercise
  • Personal care (bathing, grooming, etc.)

Telehealth and Home Care

Professional care coordination for seniors often involves home care. Seniors sometimes need help with housekeeping and personal care. WelbeHealth coordinates that care when it is medically necessary.

Telehealth can help keep seniors connected with healthcare professionals 24/7. This accessibility can help give peace of mind to seniors and their caregivers.

Coordinated Care is Impactful for Seniors.

Coordinated care is impactful for seniors with complex medical conditions. WelbeHealth provides personalized, coordinated care, keeping seniors living well, at home.

Seniors sitting on a bench

Depression in Seniors: What Caregivers Should Know

Feeling down is a normal part of life. We all have days we feel sad. But, if your loved ones’ sadness is continuous, they could be suffering from depression.

Depression is not a normal part of aging. Watch for any signs of depression. If your aging loved one shows symptoms, you can help them get the treatment they need to enjoy life again.

What Causes Depression in Seniors?

About 1% to 5% of older adults are depressed. If your loved one requires home care, they’re at an increased risk for depression. For seniors who need home health care or hospitalization, the number rises to 13.5%.

Several factors can lead to depression in seniors. These include:

Death of loved ones. Losing a spouse, child, dear friend, or beloved pet can lead to depression. Grieving a loss is normal, but becoming depressed is not. It is important to recognize the difference between grief and depression.

Health challenges. A chronic medical condition can cause depression in seniors. For example, experiencing constant physical pain or disability can lead to depression, or worsen previously diagnosed depression.

Medication side effects. Multiple medications can sometimes interact with each other and cause depression. Medication is can be processed differently in the elderly because our bodies become less efficient at metabolizing drugs as we age. Speak with your doctor or pharmacist if you think a medication may be causing depression in your loved one.

Loss of independence and purpose. People find joy and meaning in their work, volunteer activities, and social circles. Your loved one may be deprived of these joys due to a medical condition or a loss of community.

Symptoms of Depression in Seniors

Identifying depression in seniors begins with knowing the common signs and symptoms. These can include:

  • Disregarding personal care and hygiene
  • Frequent thoughts of death and suicide
  • Increased aches and pains
  • Loss of appetite and weight loss
  • Disinterest in hobbies and socialization
  • Feeling hopeless
  • Reduced motivation and energy
  • Insomnia
  • Constant sadness and despair
  • Difficulty focusing

Rona Lomeda is a Complex Case Nurse for the seniors in WelbeHealth’s PACE services. During her 30 years of experience in behavioral health and senior care, she’s become familiar with the red flags of depression in seniors.

“If a senior lives alone and is constantly feeling sad or hopeless, those are some early signs of depression,” she said.

Types of Depression Experienced by Older Adults

Several types of depression may affect seniors. These forms of depression are slightly different, but all are treatable with the help of a medical and mental health professional.

Major Depressive Disorder: Major depressive disorder (MDD) is one of the most common mental disorders in the U.S. Your loved one may experience a depressed mood every day for 14 days or longer. MDD may be a single episode, or it may reoccur.

Persistent Depressive Disorder: Also called dysthymia, this is a long-term depressed mood. It may last for at least two years. The severity of the depression may lessen at times, but your loved one will exhibit a chronically depressed mood.

Seasonal Affective Disorder: During the fall and winter months, there is less daylight, and we don’t get out as much due to the cold. As a result, seniors may experience depression during this season.

Treatment for a Senior with Depression

Getting treatment for a senior with depression can help them get back to enjoying life and prevent the worsening of symptoms. Untreated depression has is linked to chronic heart failure in the elderly, drug and alcohol abuse, and suicide.

“Depression can become worse if it is left untreated,” said Lomeda. “Getting seniors the support they need can make all the difference.”

Speaking with your loved one and their doctor about your concerns can be an initial step to getting treatment. From there, the physician can diagnose the condition and provide appropriate treatment.

Typical treatment for a senior with depression can include speaking with a licensed mental health professional. This can help your loved one work through challenging thoughts and emotions. The professional can also give your loved one tools to manage their depression. In addition, a physician or psychiatrist may prescribe antidepressant medication. These medicines work by balancing hormones in the brain that affect mood.

Senior oral health

Why Senior Oral Health Matters in Golden Years

Keeping your pearly whites cared for is critical at any age, but especially in your golden years. Good senior oral health and a smile boosts your confidence, keeps you enjoying nutritious foods, and promotes good health. Although Medicare doesn’t cover routine dental care, it’s important to visit your dentist regularly and to keep up with your at-home care to prevent serious oral issues.

Common Oral Health Concerns for Older Adults

Decay in your mouth can impact other parts of your body, including your heart and lungs. Good senior oral health can keep these common health issues at bay.

  • Gum DiseaseAccording to the CDC, 70 percent of Americans age 65 and older have periodontal (gum) disease gum. Gum disease develops when bacteria in the mouth infect the gums. Risk factors for gum disease include smoking, crooked teeth, diabetes, and poor oral hygiene.
  • Tooth Loss – As children, we proudly flash our toothless grins. But, when we are adults, tooth loss can be devastating. Sadly, 27 percent of seniors over age 65 have no remaining teeth. Caused by poor oral health and untreated gum disease, tooth loss can have a negative impact on nutritional health and self-confidence.
  • Diabetes – People with diabetes are at a higher risk for gum disease, according to the American Dental Association. This is because excess glucose in the salvia feeds bacteria in the mouth, causing it to grow, eventually evolving into gum disease. A serious infection, like gum disease, can cause your blood sugar to rise. So, the bottom line is, keeping your blood sugar under control prevents gum disease and vice versa!
  • Pneumonia – When particles of food remain in your mouth, or you have an infection in your mouth, it can create problems for your lungs. When you inhale through your mouth, bacteria or food particles can be taken in, which can lead to pneumonia. Seniors are at a higher risk for complications from respiratory infections like pneumonia.
  • Heart Issues – Endocarditis is inflammation of the inner lining of the heart. It can be caused when an infection in your mouth spreads to your heart. Though it can be usually treated successfully with antibiotics, it can strain and damage the heart.

Oral Health Concerns in Older Adults Can Impact Quality of Life

Aching teeth or tooth loss can affect your appetite. You may feel hungry, but the pain in your mouth can cause you to eat less food. This can lead to depression, weight loss and a lack of vital nutrients.

Poor senior oral health can lead to bad breath, tooth decay, and even affect your ability to speak. These things can decrease self-esteem.

But there is plenty you can do to keep your teeth healthy.

1.   Quit Smoking

Tobacco use is linked to many oral health problems. Quitting smoking can be challenging, but your mouth and body will thank you! If you’re having trouble, talk to your doctor about medications that may help you kick the habit.

2.   Brush and Floss

Brushing twice a day and flossing once a day is an easy change you can make right away to improve oral health. If it’s in your budget, buy an electric toothbrush. If you’re an older adult with arthritis, an electric toothbrush may be easier to use than a traditional brush.

3.   Clean Your Dentures

Senior oral health can be impacted by dentures, which can be a magnet for bacteria. If you wear them, make sure you’re cleaning them nightly. Visit your dentist so they can do a thorough cleaning and make any adjustments to your dentures if they aren’t fitting quite right.

How Often Should Seniors Visit the Dentist?

Mark your calendar! You should be visiting your dentist at least twice a year. These regular check-ups and screenings are your key to preventing gum disease and diagnosing oral health concerns in older adults such as cavities, receding gum lines, and cancer.

Affording Dental Care for Better Senior Oral Health

A common concern among older Americans is how to afford dental care. Staying current on your bi-yearly cleanings is beneficial for your teeth and wallet. The regular cleanings can prevent serious (and often expensive) issues from developing in your mouth.

If you’re looking for an alternative to paying out-of-pocket for dental care, WelbeHealth provides program participants with comprehensive dental care services. Oral care is an integral part of WelbeHealth’s holistic approach to caring for seniors.