How Newsom Budget Yanks Back Medi-Cal Health Care Gains for Low-Income Residents

By | Health Disparities, Health Equity, IN THE NEWS, Medicaid, Newsroom

Cal Matters: How Newsom Budget Yanks Back Medi-Cal Health Care Gains for Low-Income Residents (May 18, 2020)

The state’s revised budget released last week shows that the Golden State’s new economic reality will almost certainly hit the Medi-Cal program with cuts in services and provider rates, as well as rescinded expansions. The list of proposed changes is sweeping, from canceling coverage expansion to more older Californians – including undocumented seniors – to cuts in some adult dental services.

“I think there will be a huge effort within the next few weeks to see whether we can push back on this,” Ramsey said. “If we don’t get to go forward now, it will likely take years.”

Free Webcast: Medicare Coverage and COVID-19

By | DUAL ELIGIBLES, Health Care, Medicaid, Medicare, WEBINAR, Webinar Trainings

The Centers for Medicare & Medicaid Services (CMS) and new legislation have changed many of the rules in Medicare to respond to COVID-19. This webcast focuses on the changes to Medicare that most impact low-income older adults.

Who should participate:
Aging and legal advocates serving older adult Medicare beneficiaries who want to learn more about navigating the changes at CMS on behalf of their clients.

Amber Christ, Directing Attorney, Justice in Aging
Natalie Kean, Senior Staff Attorney, Justice in Aging

This webcast took place on Tuesday, April 14, 2020, at 11:00 a.m. PT/2:00 p.m. ET.


Economic challenges face elderly Americans during Covid-19 shutdowns

By | Economic Security, Health Care, IN THE NEWS, Medicaid, Medicare

KFTK St. Louis, The Randy Tobler Show: Economic challenges face elderly Americans during COVID-19 shutdowns, (April 7, 2020)

Amber Christ, Directing Attorney with Justice in Aging, joined Randy to discuss the challenges elderly Americans face during the Covid-19 pandemic.

Following the passage of the CARES Act, rebates were approved to help stimulate the economy, $1200 dollars per person which most will be received automatically.  This also includes those that receive Social Security retirement or Social Security Disability. Amber discusses, this as well as some of the health care provisions in the CARES Act.

Summary: How States are Modifying HCBS Programs to Address COVID-19 Emergency

By | Health Care, Home & Community Based Services, Medicaid, Medicare, REPORTS

The Centers for Medicare & Medicaid Services (CMS) has begun reviewing and approving states’ emergency requests to modify their home and community-based services (HCBS) waivers. These approvals, documented through CMS’ Appendix K form, list the many modifications that CMS has approved in the past week.

As an aid to advocates, providers, and policy-makers, Justice in Aging is reviewing and summarizing the CMS approvals pertaining to aging-focused HCBS waivers. This summarized information, organized by the same categories used in Appendix K, can be a guide for advocates and others to identify useful modifications and flag others that may be problematic or otherwise unwanted.

Free Webinar: Updates on Public Charge & Older Immigrants

By | Medicaid, Medicare, Safety Net Defense, WEBINAR

When: Monday, March 9, 2020 from 11 -11:30 am PT/2-2:30 pm ET

In January, the U.S. Supreme Court removed the nationwide temporary injunction that had prevented the Department of Homeland Security (DHS) public charge immigration rule from taking effect. This means that the public charge rule that DHS finalized last August can go into effect nationwide, except in Illinois, where it is blocked by a statewide injunction. DHS announced that it will begin implementing the final rule on February 24th.

The Supreme Court’s decision endangers the health and well-being of older immigrants and their families and cruelly impedes the path to citizenship and family unification. However, it is not a final decision and we must continue to fight to stop this harmful policy from becoming permanent. The multiple cases challenging the underlying legality of the final public charge rule will continue in the courts. DHS has appealed all the district court decisions that issued preliminary injunctions to the Second, Fourth, Seventh, and Ninth Circuits. DHS has also asked the U.S. Supreme Court to hear the case.

Justice in Aging and our partners have filed amicus briefs in the Second and Ninth Circuits to ask the court to affirm the district courts’ nationwide injunctions and to highlight the ways in which this rule unfairly targets older immigrants, their families, and caregivers. This webinar, Updates on Public Charge & Older Immigrants, will begin with an overview of the public charge test and how it applies to older adults, discuss the current state of litigation, and provide information on what advocates need to know about the rule’s implementation.

Who should participate:
Aging and legal advocates, advocates serving immigrant communities, community-based providers, and others wanting to learn more about how changes to the public charge test and implementation of the new regulations impact older immigrants.

Denny Chan, Senior Staff Attorney, Justice in Aging
Natalie Kean, Senior Staff Attorney, Justice in Aging

This webinar took place on Monday, March 9, 2020, from 11 -11:30 am PT/2-2:30 pm ET. 

Closed captioning will be available during this webinar. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webinar start time.


Medicaid’s Built-in Solution to Protect People from Crushing Debt

By | BLOG, Medicaid

Medicaid Retroactive Coverage: A Safeguard against Crushing Medical Debt & Key to Accessing Care

Carol was hospitalized after an accident in August. Although she did not apply for Medicaid until October, Medicaid’s retroactive coverage protection ensured that the Michigan Medicaid agency covered her medical bills totaling nearly $50,000 dating back to August.

John experienced a major medical crisis requiring him to stay in the hospital for 86 days. The total charges for his care exceeded $1 million. Because John was uninsured and low-income, the hospital’s staff prepared a Medicaid application, a process which took 65 days to complete. The Florida Medicaid agency approved the application and covered bills for the previous 90 days.

In both of these situations, Medicaid’s retroactive coverage protection filled in gaps for people who neither had nor could afford private health insurance. Without it, Carol and John would have been saddled with unaffordable bills, and likely been caught in medical debt and perhaps even bankruptcy.

Many people like Carol and John turn to Medicaid when they face significant or unexpected health care costs. In fact, the program is uniquely designed to respond to this need—federal law requires state Medicaid agencies to pay for care and services that an eligible person received before they formally applied for coverage. Congress created this 90-day retroactive coverage period because it recognized that people cannot always apply for Medicaid as soon as they become eligible and often do not even know they might be eligible. Medicaid applications are complicated, and it often takes states several weeks or months to determine eligibility, especially when the applicant needs long-term services and supports.

Retroactive coverage is a key financial protection for older adults and other people who are low-income, uninsured, and underinsured. It is the only safeguard against debt and bankruptcy if these individuals experience a health emergency, need long-term services and supports following an illness, or have other unexpected high-cost health care needs. Medicaid retroactive coverage also opens the door to accessing necessary care and helps lessen the uncompensated care burden on providers, particularly nursing facilities and hospitals that serve a large percentage of low-income patients, making it possible for them to stay open and continue to serve their communities.

Despite the importance of this protection, a growing number of states are eliminating retroactive coverage through waivers of federal Medicaid law. Our issue brief takes a deep dive look at some of these states and how their waivers harm older adults, providers and even the state itself. Bottom line: neither older adults and their families nor our healthcare system can afford to lose this protection.

Advocates Pleased CMS Aims To Rein In D-SNP Look-Alikes, But Worried CMS May Miss Some

By | Health Care, IN THE NEWS, Medicaid, Medicare

Inside Health Policy: Advocates Pleased CMS Aims To Rein In D-SNP Look-Alikes, But Worried CMS May Miss Some (February 12, 2020)

“Beneficiary advocates say they are pleased CMS appears to be taking seriously the issues with so-called look-alike plans that mimic Dual Eligible Special Needs Plans yet don’t have the same Medicare and Medicaid integration requirements – but some worry that CMS’ proposed threshold for stopping these plans may be set too high. Allowing the plans to simply enroll beneficiaries in one of their other products if a look-alike is shut down may not be enough of a disincentive, some say…” This article is behind a paywall. This is an excerpt of the piece.

What Seniors Need To Know About Trump’s 2021 Federal Budget

By | Affordable Care Act, IN THE NEWS, Long Term Care, Medicaid, Safety Net Defense, SENIOR POVERTY, Social Security

Forbes: What Seniors Need To Know About Trump’s 2021 Federal Budget (February 10, 2020)

President Trump’s proposed 2021 Federal Budget would cause serious harm to low income older adults. The budget proposal includes cuts to critical programs that serve low income older adults, including Social Security Disability Insurance, Medicare, and Medicaid. The budget would also cut funds to federal grant programs that would impact Meals on Wheels, utilities assistance, senior job programs, and legal aid for seniors. “This budget demonstrates the lack of commitment to the safety, security and needs of older adults in our community,” said Kevin Prindiville, Justice in Aging’s Executive Director.

Justice in Aging Joins Amicus Brief Urging the Supreme Court to Defend the ACA

By | Health Care, Medicaid, Medicare, PRESS RELEASE
On January 15, Justice in Aging joined AARP and the Center for Medicare Advocacy in submitting an amicus brief urging the U.S. Supreme Court to expedite its review of a case challenging the constitutionality of the Affordable Care Act (ACA). The brief argues that the uncertainty caused by the Fifth Circuit’s decision to remand the case to the district court is harming older adults and that declaring the entire ACA unconstitutional will cause millions of older adults to lose health insurance coverage and vital consumer protections. Read More

Fact Sheet: Coverage Changes for Opioid Treatment Services for Dually Eligible Individuals

By | FACT SHEET, Health Care, Medicaid, Medicare, REPORTS

As of January 1, 2020, Medicare Part B covers a new Opioid Treatment Program (OTP) benefit. This means Medicare beneficiaries now have access to methadone for medication-assisted treatment (MAT) in an out-patient setting, along with counseling and other opioid use disorder (OUD) treatment services delivered by a certified OTP provider.

For individuals dually eligible for Medicare and Medicaid, this new coverage means that Medicare is now the primary payer for these OUD treatment services. The Centers for Medicare & Medicaid Services (CMS) has issued guidance to OTP providers, MA plans and to states to help ensure that dually eligible individuals who are currently receiving these OUD treatment services do not experience interruptions in care.

Justice in Aging’s new fact sheet describes the new OTP benefit and how it affects dually eligible individuals access to treatment for OUD. Advocates working with dually eligible individuals or other Medicare beneficiaries receiving or in need of OUD treatment services should become familiar with these changes to help clients navigate and identify any issues.

For example:

  • OTP providers and MA plans are prohibited from billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost-sharing for OTP services. In addition, all people enrolled in Original Medicare should not pay any cost-sharing for OTP services once they have met their Part B deductible.
  • States, MA plans, and providers should be following guidance to ensure continuity of care for dually eligible beneficiaries who are currently receiving OTP services.
  • State Medicaid programs cannot exclude or deny coverage of transportation (NEMT) for dually eligible individuals to Medicare-covered benefits, including OTP services.

Please let us know if you observe any issues with these changes in Medicare coverage of OUD treatment services. Your feedback helps us identify systemic issues and work with CMS to resolve them.