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Better-coordinated care for those eligible for both Medicaid and Medicare holds promise for improving health, while curbing costs


Ruth McEwen suffered a broken neck and nearly died in a devastating house fire when she was 3 months old. The fire killed her mother and severely burned her father — and left Ruth a quadriplegic from spinal cord injuries.

"I don't have control of my limbs," she says.

Federal and state health coverage for people with disabilities depends on their age, level of disability and income. Navigating those benefits and their shifting eligibility rules can be daunting — especially for the roughly 60,000 "dually eligible" Oregonians who qualify for both Medicare and Medicaid.

Most people become eligible for Medicare at age 65. But some younger people are eligible because of a disability. They may also qualify for Medicaid coverage if they have low incomes.

Ruth McEwen
Ruth McEwen has served on the Medicare-Medicaid Integration of Care and Services Work group. She's on the Oregon Disabilities Commission, the Oregon Health Authority's ombudsman advisory committee and the legislative committee of Northwest Senior and Disability Services.

As a member of numerous advisory committees in Oregon, McEwen helps make sure people know what coverage they qualify for, so they don't get left behind when their eligibility shifts. She served on the Medicare-Medicaid Integration of Care and Services Work Group. She's on the Oregon Disabilities Commission, the Oregon Health Authority's ombudsman advisory committee and the legislative committee of Northwest Senior and Disability Services.

Better-coordinated care for people eligible for both Medicaid and Medicare — a major goal of health transformation in Oregon — holds promise for improving their health while curbing public spending.

People often are surprised to learn how many adults with spinal cord injuries and other disabling conditions, such as McEwen, still live independently in their own homes.

Technological advances have helped. For about 20 years, McEwen has used a transfer board — with a sliding seat — to get in and out of bed or the shower.

"What Medicare paid for that," she says, "is a tiny fraction of what it would cost to have someone come in every day to help me get out of bed."

McEwen calls herself a person with disabilities, rather than a disabled person. The latter term, she says, misleadingly defines people by their physical limits.

"We are people first," she says.