1. Why Advocacy? Why Now? Medicare and Beyond Lorrie McCann, LMHC, CT

2. Objectives 1)Answer the question: Why Advocacy? Why Now? 2)Historical Perspective 3)Current Situation 4)Mental Health Needs for Seniors 5)Grassroots Advocacy My goal: Heighten Your Interest and Stir Your Passion

3. All Politics is Local (Tip O’Neill) or Personal  My Story  The shrinking job market for LMHC’s due to employer reluctance to hire LMHC’s in areas with high Medicare populations  This is particularly true in Florida which has the highest percentage of people over 65 in the country.  The desire and the training to serve the Medicare population but finding limited opportunities

4. We Were Young and Not Included  Historical Background to Medicare Legislation 1933 Private hospital insurance approved by the American Hospital Association leading to the establishment of Blue Cross August 14, 1935 Social Security Act signed into law – health insurance excluded January, 1943 President Roosevelt in his State of the Union calls for insurance from “ from the cradle to the grave”

5. Medicare History Continued  April 1951 Social Security Annual Report recommends health insurance for beneficiaries  August 27, 1957 Forand Bill HR 9467 to provide health insurance for social security beneficiaries introduced  July-August 1961 Ways and Means Committee conducts hearings on Medicare bill  July 30, 1965 Medicare as an amendment to Social Security Act signed into law by President Johnson under Title XVIII of the Social Security Act  In 1984 Hospice benefit was added and 2003 prescription drug benefit The House and Senate have twice passed legislation to include LMHC’s and MFT’s as Medicare providers but not at the same time. Neither group was included as providers initially and this has not changed. Today there is a bill in the Senate SB562 and as of December, 2013 a companion bill in the House HB 3662 to include LMHC’s and MFT’s as Medicare providers

6. It’s a Game Changer Affordable Care Act  ACA adds millions of beneficiaries through Medicaid expansion and health exchanges  Parity will increase those seeking care for substance abuse and mental illness  Shift to Accountable Care Organizations (ACO’s) an integrated care model designed to focus on managing the healthcare of the beneficiary with the goal of improved outcomes  The ACO’s focus on preventing illness rather than treating the disease creates a huge opportunity for LMHC’s but not if they’re excluded from insurance panels  Trial ACO’s implemented since 2011 are demonstrating cost savings!!  Medicare exclusion will be a major barrier for LMHC’s seeking participation in ACO’s as integrated networks become way of managing healthcare

7. The Baby Boomers Are Coming  Mental Health and Seniors  At least 5.6 million to 8 million Americans age 65 and over suffer from a mental health or substance abuse disorder according to a recent report by the Institute of Medicine (Reported by CBS News 7/11/12)  Report co-author Dr. Peter Rabins a psychiatrist at Johns Hopkins states that this number is sure to grow as the senior population nearly doubles by 2030.  Dr. Ken Duckworth of the National Alliance on Mental Illness says, The coming need for geriatric mental “is quite profound for us as a nation.”

8. Key Senior Mental Health Issues  Untreated depression impacts the management of diabetes, hypertension and many other health problems There is a significant co-morbidity between Depression and Heart Failure (or Congestive Heart Failure, a condition where the heart can’t pump enough blood) research shows that depressed people are less likely to be compliant with treatment – depressed people with HF have poorer outcomes including death  Grief is a pervasive issue for the senior population as they cope with retirement and the loss of spouse, friends and health

9. Substance Abuse and the Elderly  One third of alcoholics develop a problem later in life  Heavy drinking is defined by 2 or more drinks/ days  In community based study of people 60-94 years 6 % met this criteria  Bereavement and retirement may trigger late onset drinking in some  The effects of alcohol at the cellular and organ level are more significant due to the physiological changes due to aging  Increase fall risk  Delirium and cognitive dysfunction  Drug Interactions  Immunosuppression leading to increase risk for pneumonia

10. Let Your Voice Be heard  Practical Steps to Grassroots Advocacy  Do your research – learn about the issues  Join your professional organizations local, state and national  Do more than pay dues, get involved  Be persistent, be respectful  Use the advocacy tools provided by your professional organizations  Write letters, ask for a meeting with your legislator

11. Resources  AMHCA Website www.amhca.orgwww.amhca.org  FMHCA Website www.fmhca.orgwww.fmhca.org  U.S Senate www.senate.govwww.senate.gov  US House of Representative www.house.govwww.house.gov  Macchio A, Monte S, Pelligrini F et al: Depression Worsens Outcomes in Elderly with HF: European Journal of HF, 2008;10:714-721  Gardner A: Aging Baby Boomers Mental Health Woes Will Swamp Health System: US News & World Report, 7/10/12  Rigler S: Alcoholism in the Elderly: American Family Physician; 2000 Mar 15: 170-1716