Series examines the ways in which the financial and emotional toll of providing and paying for long-term care are wreaking havoc on the lives of millions of Americans.

Today, KFF Health News and The New York Times published the first phase of an investigation into America’s long-term care crisis, which has left many in the boomer generation facing the prospect of exhausting their financial resources as the price tag for care explodes. Dying Broke, the investigative series, uses KFF polling, original analysis and interviews with experts and impacted individuals and their families to examine the challenges facing families and caregivers in navigating long-term care.

The financial and emotional toll of providing and paying for long-term care is wreaking havoc on the lives of millions of Americans. Paid care, either at home or in a facility, is often so expensive that only the wealthy can afford it, and many of the for-profit companies providing care raised their prices sharply during the pandemic. The ongoing shortage of health care workers is also worsening the situation.

The project found that nearly three million older Americans who need long-term help are not receiving it, in large part because of the high costs of assisted living facilities, nursing homes and aides at home. The United States spends less on long-term care than do most wealthy countries. As part of this project, KFF conducted polling to help shed light on the U.S. public’s awareness of, attitudes about and experiences with long-term care services and supports.

The series tells the stories of some of the many people who must drain their lifetime savings to pay for care as well as the stories of the spouses and children, particularly daughters, who must make tremendous sacrifices to provide care. The first articles appear today on kffhealthnews.org and nytimes.com.

“There’s a reason this topic is a staple of so many family Thanksgiving dinner conversations,” said Jordan Rau, a senior correspondent at KFF Health News. “The kinds of no-win choices facing the people and their families we profile in these articles are ones that can happen to anyone—and too often do.”

“In interviewing many families with aging relatives, I was struck by how woefully unaware people are of how much long-term care can cost,” said Reed Abelson, health care reporter at The New York Times. “Many are amazingly resilient in finding ways to get care for their loved ones, but the lack of available help means people are often making tremendous sacrifices, both financially and emotionally, to provide support.”

The series includes reporting from Jordan Rau, senior correspondent at KFF Health News; Reed Abelson, health care reporter at The New York Times and JoNel Aleccia, formerly at KFF Health News. Holly K. Hacker, KFF Health News’ data editor, and Albert Sun, a graphics editor at The New York Times, conducted data analysis.

Read Dying Broke

Pennsylvania is in the process of restoring Medicaid coverage for 105,000 residents who lost their government-funded health insurance benefits this year because they did not return a form on time or for some other procedural reasons. The coverage terminations happened as Pennsylvania and other states in April resumed checking the eligibility of Medicaid beneficiaries, who qualify based on income level or disability status. The Medicaid review process had been suspended nationwide for three years during the COVID-19 pandemic.

Read the full article:  The Philadelphia Inquirer: Pennsylvania Medicaid Benefits Being Restored To 105,000 Residents

On November 2, the Centers for Medicare & Medicaid Services (CMS) finalized calendar year 2024 (CY 2024) policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues. Under CY 2024 PFS, pay rates will be reduced by 1.25 percent and the PFS conversion factor will decrease by 3.4 percent to $32.74. CMS is also finalizing significant increases in payment for primary care and other kinds of direct patient care. Marriage and family therapists (MFTs) along with mental health counselors are eligible to receive payment for mental health services and substance abuse treatment, including services furnished in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Payment for telehealth services furnished in RHCs and FQHCs is extended until December 31, 2024. In addition, CMS has created two new billing codes to describe services performed by auxiliary personnel including community health workers (CHWs) under the general supervision of the billing practitioner. The final rule is effective January 1, 2024.

Last week, the Centers for Medicare & Medicaid Services (CMS) finalized calendar year 2024 payment rates and policy changes for hospital outpatient facilities and Ambulatory Surgical Centers.  In addition to increasing pay rates by 3.1 percent, this rule establishes an intensive outpatient program to serve beneficiaries who require more intense mental and behavioral services than traditional outpatient therapy but less than inpatient-level care. Hospital outpatient departments, as well as federally designated Community Mental Health Centers, Federally Qualified Health Centers, Rural Health Clinics,  or Opioid Treatment Programs may provide these services.  The rule also finalized the adoption of four measures for the Rural Emergency Hospital (REH) Quality Reporting program and a policy that Indian Health Service and Tribal facilities that become REHs will be paid for hospital outpatient services using their current all-inclusive rate. These facilities will also receive the REH monthly facility payment.  Finally, this rule updates Hospital Price Transparency requirements to increase standardization of the data files, clarify how to find the files online, and add provisions on how compliance will be enforced. The final rule is effective January 1, 2024.

 The Economic Research Service at the U.S. Department of Agriculture (USDA) published a new report analyzing the areas and populations served by three USDA rural broadband programs: 10 the Broadband Initiatives Program (BIP), 2) the Community Connect grant program, and 3) the ReConnect program. The study reported the populations served by all three programs were found to be more rural, less educated, poorer, and older than those in areas not served or ineligible. In 2021, 41 percent of households in nonmetropolitan (nonmetro) areas lacked wired high-speed internet service in their homes, compared to 27 percent of metropolitan (metro) households. In addition, a 2020 study published by the Federal Bank entitled Bringing Broadband to Rural, demonstrated broadband access and adoption in rural areas is linked to increased job and population growth, higher rates of new business formation and home values, and lower unemployment rates. For rural healthcare facilities, broadband assists in increasing access and quality services through creating infrastructure to send electronic files, support patient portals, and complete telehealth visits.

The U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) announced more than $80 million in awards to rural communities in 39 states to support key strategies to respond to the overdose risk from fentanyl and other opioids. These awards help advance President Biden’s commitment to beat the opioid epidemic as part of his Unity Agenda for the nation.

HRSA funding will support interventions such as distributing the lifesaving overdose reversal drug naloxone to prevent overdose; creating and expanding treatment sites in rural areas to provide medications to treat opioid use disorder; expanding access to behavioral health care for young people in rural communities; and, caring for infants in rural areas who are at-risk for opioid exposure or experiencing symptoms related to opioid exposure.

“Far too many rural families have faced the devastation of overdose, and these deaths are felt deeply across rural communities – where often everyone knows someone lost too soon,” said HRSA Administrator Carole Johnson. “At the Health Resources and Services Administration, we know that funding based on population size or other broad-based rubrics can miss the vital treatment and response needs of rural communities. That’s why the investments we are announcing today are targeted to rural communities and tailored to the unique challenges of helping rural health care leaders expand access to treatment and build recovery pathways to prevent overdose.”

More than 100,000 people die each year from overdose. Individuals who call rural communities home and who are experiencing opioid use disorder – including from fentanyl, heroin or other opioids – can face challenges in accessing treatment and recovery services. Geographic isolation and transportation barriers can make finding treatment particularly challenging and limited mental health and substance use disorder health care providers in the community can further complicate access. The stigmatization of substance use disorder and its treatments are additional barriers to access. HRSA’s funding is targeted to helping communities address these critical needs and expand access to services.

Today’s announcement includes the following investments:

• Expanding Access to Medication to Treat Opioid Use Disorder: $24 million will support 26 awards to rural communities to establish treatment sites for individuals to access medications to treat opioid use disorder. The use of medication to manage opioid use disorder is the standard of care, but not always readily available.
• Supporting Rural Communities in Preventing and Responding to Overdoses: $14 million will support 47 awards to help rural communities respond to their specific and immediate needs, including the distribution of life-saving opioid overdose reversal medications.
• Meeting the Behavioral Health Needs of Young People: Nearly $9 million will support 9 awards to focus on building, strengthening and expanding mental health and substance use disorder services for young people in rural communities to expand treatment and help prevent overdose.
• Preventing and Addressing Neonatal Exposure: Nearly $20 million will support 41 awards to develop and implement interventions in rural communities to prevent, treat and care for opioid exposed infants by focusing on systems of care, family supports, and social determinants of health.
• Investing in and Disseminating Best Practices: $10 million will support three Rural Centers of Excellence on Substance Use Disorders to disseminate treatment and prevention best practices to help inform rural communities’ response strategies, and $5 million will support evaluation of this overall initiative.

To view the full list of awardees, see https://www.hrsa.gov/rural-health/opioid-response/fy2023-rcorp-awards-overview.

To learn more about the RCORP program, visit the RCORP Webpage.