Episode Details

In this episode of Global Economic Press, Alex Brady discusses a groundbreaking initiative by ATI Advisory aimed at reshaping how Medicare supports the "Overlooked Middle" — individuals who fall between Medicaid eligibility and the ability to self-fund their long-term care needs. The Medicare Advancing Home and Community Care model, developed with actuarial analysis by Milliman, is a proof-of-concept that demonstrates Medicare's potential to finance targeted home and community-based services for beneficiaries with significant functional needs while maintaining or reducing Medicare spending. This innovative approach is projected to save over $500 million and is part of California’s Master Plan for Aging Long-Term Services and Supports Financing and Affordability Initiative.

The model addresses a critical gap in services for the "Overlooked Middle," who often face increased risks of hospitalization, institutionalization, financial strain, and caregiver burnout due to unmet functional needs. ATI Advisory's data-driven model design includes frailty screening, service navigation, and a flexible home and community-based services benefit capped at $2,500 annually. Milliman's actuarial modeling projects approximately $528 million in net Medicare savings over a 10-year period. While the analysis is based on California-specific data, the report suggests that the concept could be applicable across states without requiring additional Congressional action. For more information, visit ATI Advisory's website.