All Posts By

Katrina Cohens

New Fact Sheet: The Dangers of AHCA for Older Adults

By | FACT SHEET, Health Care, Medicaid, REPORTS | No Comments

Because of the Affordable Care Act (ACA), more older adults get health insurance coverage and receive the supports they need to remain in their homes as they age. The American Health Care Act (AHCA), the Republican “repeal and replace” bill, would take away health insurance for 24 million Americans and cut Medicaid funding by 25 percent over the next ten years.

The bill poses many dangers for older adults today and in the future, as it would:

  • Raise the costs of insurance and health care
  • Put pressure on state budgets
  • Lead to cuts in services
  • Undermine the financial stability of Medicare

Read our fact sheet for more information

QMB Identification Practices: A Survey of State Advocates

By | ISSUE BRIEF, Medicare, REPORTS | No Comments

Ensuring that Qualified Medicare Beneficiaries (QMBs) are not illegally billed for Medicare costs requires improvements on many fronts. One important piece is better identifying QMBs and informing both QMB consumers and their providers that they are subject to billing protections. Justice in Aging is pleased to share two new important resources contributing to that effort.

QMB Identification Survey
The new issue brief, authored by legal services attorney Peter Travitsky, looks at practices in 13 states in identifying QMBs. It finds that, although several states provide no QMB identification cards, others offer examples of best practices to ensure that QMB consumers and their providers know their protected status. The survey was supported by a post-fellowship grant from the Borchard Foundation Center on Law and Aging.

Incorporating QMB protections into Medicare notices
In October 2017, the Medicare program will be rolling out revised Medicare Summary Notices (MSNs) to QMB consumers and revised remittance advice notices to providers. On both notices, for each covered service, a notation will show that the individual is a QMB and that the co-insurance responsibility for each service is zero. To prepare providers for the revised system, CMS released a new Medicare Learning Network Matters article, Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System. As the new system is implemented, the article will be a useful tool for advocates to share with providers and their billing departments.

Visit the improper billing webpage, where you can find many more resources including a toolkit that with model letters to providers, an issue brief on recent improvements in QMB reporting and enforcement, recordings of past webinars on QMB billing and other valuable tools, including an improper billing tracking form that you can use to report instances of improper billing to inform our advocacy.

Fact Sheet: Medicaid Caps & Cuts Harm Older Women

By | FACT SHEET, Medicaid, REPORTS | No Comments

Medicaid provides essential care for women throughout their lives—from family planning and maternal health services to nursing home care. However, yesterday, on International Women’s Day, committees in Congress were busy marking up a GOP ACA replacement bill that will fundamentally change the way Medicaid is funded, making it harder for both older and younger women to be able to pay for health insurance, visit their doctors, and receive long-term care.

These changes to our health care system will make care unaffordable and inaccessible for many, but women will be disproportionately impacted. We laid it out in this new fact sheet, Medicaid Caps and Cuts Harm Older Women, produced in partnership with our friends at the National Partnership for Women & Families. Read and share this fact sheet with other advocates, lawmakers, and others.

For more recent Justice in Aging health care defense resources visit this page. If you missed our webinar on Medicaid cuts and caps earlier this week, you can watch the recording here.

Justice in Aging Statement on the American Health Care Act

By | Health Care, Medicaid, PRESS RELEASE | No Comments

Washington, DC (March 8, 2017) – This statement is from Kevin Prindiville, Executive Director at Justice in Aging, on the American Health Care Act:

“Republican lawmakers in the House have drafted an ACA replacement bill, the American Healthcare Act (AHCA), that is an attack on the health and long-term care needs of older adults. This bill makes health care more expensive, targeting older adults for the deepest cuts in services and the largest increases in cost.”

“We are particularly opposed to the Medicaid cuts at the heart of this bill.  The bill fundamentally changes the promise and structure of Medicaid by capping federal funding for the program at levels that, by design, will leave states without enough funds to meet the health and long-term care needs of older adults over time. Over 6 million older adults rely on Medicaid, and 2/3 of all Medicaid spending for older adults goes to essential long term care services in nursing homes and at home and in the community.  AHCA threatens the care of all of these seniors and the peace of mind of their families.”

“In addition, AHCA makes it harder for older adults age 55-64 to access health care coverage.  By freezing the Medicaid expansion, the bill takes care away from the many low-income older adults age 55-64 who rely on Medicaid to see their doctors and meet their medical needs before they qualify for Medicare. By allowing insurance companies to charge older adults more than 5 times as much for their care, the bill creates what is effectively an “age tax” that will make care for many older adults completely unaffordable.”

“AHCA makes these cuts to the health care of older adults in order to pay for tax cuts for the wealthy. These tax cuts will negatively impact the solvency of the Medicare trust fund, harming the Medicare program for current beneficiaries and those who will rely on it in the future.”

“The American Healthcare Act conflicts with the President’s own promises that he would not touch the safety net upon which seniors rely.  Moreover, lawmakers are attempting to ram it through Congress, without hearings and without complete analysis of just how many millions of people will lose coverage under the plan.”

Justice in Aging is a national non-profit legal advocacy organization that fights senior poverty through law. Formerly the National Senior Citizens Law Center, since 1972 we’ve worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency. Through targeted advocacy, litigation, and the trainings and resources we provide to local advocates, we ensure access to the social safety net programs that poor seniors depend on, including Medicare, Medicaid, Social Security, and Supplemental Security Income (SSI). 

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Contact: Vanessa Barrington
510-256-1200 direct
vbarrington@justiceinaging.org

Fact Sheet: Supplemental Security Income (SSI)

By | FACT SHEET, Income Network Alert, REPORTS, Social Security | No Comments

Millions of seniors and people with disabilities rely on Supplemental Security Income (SSI) to make ends meet. There are people relying on SSI to survive in every community in the country. The majority of SSI recipients are women, and the program is especially beneficial for people of color and people with limited English proficiency. It’s also an essential safety net for older adults who do not receive sufficient Social Security income because they worked in low-wage or seasonal jobs, or stayed home from work to care for family members.

With leaders in Congress intent on cutting safety net benefits, it’s critical that advocates proactively educate lawmakers, the media, and fellow advocates about the important role SSI plays in ensuring that some of the most vulnerable people in our communities can meet their basic needs for shelter, food, and other necessities.

Please use this new Justice in Aging SSI fact sheet that shows who relies on SSI, why it’s important, and the dangers cuts to the program would pose for low-income families and communities.

If you would like us to insert statistics specific to your state and/or congressional district please email us for assistance.

100 Natl Orgs tell Congress to Reject Medicaid Cuts

By | PRESS RELEASE | No Comments

Washington, DC—Today, the Medicare Rights Center, Justice in Aging, the Center for Medicare Advocacy, and 97 other national organizations sent a letter to Congressional leadership expressing grave concerns with proposals that would radically change Medicaid—a vital safety net that provides quality health care and services for millions of Americans, including 10 million older adults and people with disabilities who are eligible for both Medicaid and Medicare.

Recent proposals put forward in Congress would completely restructure Medicaid’s finances, eligibility, and availability. Two ways of restructuring the program have risen to prominence: block grants and per-capita caps. While the precise workings of these proposals differ, both are designed to reduce federal support to state Medicaid programs. Cutting federal dollars will inevitably lead to fewer people covered, fewer services available, and higher health care costs for low-income families—putting older adults, people with disabilities, and their families at risk.

“Block grants and per capita caps are nothing more than cuts to Medicaid, reducing the dollars flowing to the states, rationing access to needed care, and threatening job opportunities and growth. These proposals are not focused on improving the Medicaid program, but instead put reducing federal spending over families’ needs. Therefore, we urge you to reject these structural changes to this vital safety net program,” the letter cautions.

“Medicaid caps are a Medicare cut—pure and simple. Block grants and per-capita caps threaten access to vital programs that help low-income older adults and people with disabilities afford their Medicare costs,” said Joe Baker, president of the Medicare Rights Center. “With this help, people with Medicare can stretch already limited incomes to buy groceries, pay rent, heat their homes, and meet other basic needs. Capping Medicaid could quickly impoverish people with Medicare already struggling to make ends meet.”

“The destructive cuts to Medicaid that Congressional leaders plan will unfairly target older Americans who struggle to make ends meet,” said Kevin Prindiville, executive director of Justice in Aging. “They may be unable to visit their doctors, receive life-saving preventive care, or get the help they need to age at home and in their communities safely and in dignity.”

Judith Stein, executive director of the Center for Medicare Advocacy, said, “Plans to cap Medicaid are driven by a desire to reduce federal support for low-income families and shift costs—not power—to states. Recent Medicaid proposals would hurt almost 1 in 5 families. States would get less Medicaid funding and, inevitably, provide less health coverage. Vulnerable children, people with disabilities, and older people will be disproportionately harmed. We hope thinking and caring leaders will oppose this regressive, national tragedy.”

Read the full letter.

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Justice in Aging is a national non-profit legal advocacy organization that fights senior poverty through law. Formerly the National Senior Citizens Law Center, since 1972 we’ve worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency.

The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.

The Center for Medicare Advocacy, Inc., established in 1986, is a national nonprofit, nonpartisan law organization that provides education, advocacy and legal assistance to help older people and people with disabilities obtain fair access to Medicare and quality health care. The Center is headquartered in Connecticut and Washington, DC with offices throughout the country.

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Contact: Vanessa Barrington
510-256-1200 direct
vbarrington@justiceinaging.org

Medicare Rights Center – Mitchell Clark
212-204-6286
mclark@medicarerights.org

Center for Medicare Advocacy – Matthew Shepard
860-456-7790
mshepard@MedicareAdvocacy.org

Fact Sheet: Denti-Cal for Adults

By | CA Health Network Alert, FACT SHEET, Oral Health, REPORTS | No Comments

In May 2014, dental benefits were partially restored for adult Medi-Cal recipients and are delivered through the Denti-Cal program. Unfortunately, many Medi-Cal recipients do not know they have dental coverage. Those who do know they have coverage often do not know what treatment they can obtain and have a hard time accessing benefits.

This new fact sheet, Denti-Cal for Adults, explains the basics of Denti-Cal coverage, how to access benefits, and provides a summary of what benefits are covered.

Please share broadly both within your own organization and with the consumers and clients you serve.

WEBINAR: Medicaid Funding Caps Would Harm Older Americans

By | Health Care, Medicaid, WEBINAR | No Comments
When: Tuesday March 7, 2017 at 11:00 a.m. PT/ 2:00 p.m. ET.

One result of the 2016 elections has been increased discussion of Medicaid “cap” proposals. What would happen if federal Medicaid funding were capped, and individual states were given broad authority to re-write their Medicaid programs? How could states maintain necessary health care services with drastic cuts in federal funding? What would Medicaid block grants and per capita caps mean for the older adults you serve?

This webinar explains why the cap proposals would be harmful to the over six million older Americans who rely upon Medicaid coverage. The webinar includes advocacy strategies to retain current Medicaid protections and prevent cuts—without a doubt, the next few months are critical for all who care about health care for low-income older Americans.

Read More

Fact Sheet: Medicaid Funding Caps Would Harm Older Americans

By | FACT SHEET, Medicaid, REPORTS, Uncategorized | No Comments

On February 16, 2017, Republicans released their latest proposal outlining their ideas to repeal and replace the Affordable Care Act. This proposal radically changes the Medicaid program by capping the amount states will receive in federal funding to deliver healthcare to low-income individuals. These capped proposals, either block grants or per-capita allotments, aim to catastrophically cut Medicaid and eliminate important consumer protections currently in place.

States will be forced to make difficult choices regarding what services they can deliver and what populations they will be able to serve, placing increased pressures on state budgets. Crucial programs that allow seniors to age at home rather than receiving care in institutional settings are at risk.

This latest replacement proposal does not come close to the improved coverage and affordability offered through the ACA for older adults. The plan will increase the cost of care and limit access to health care for older adults, especially low-to-middle income older adults. Specifically, the plan decreases tax credits, reintroduces high-risk pools for the most sick, and increases the availability of health savings accounts that provide little benefit for low to middle income consumers.

Justice in Aging has developed a new fact sheet showing how cuts to Medicaid through capped Medicaid funding would hurt older adults. For more detailed information on how capped funding would impact older adults, see our issue brief.

Judge Allows Medicare Observation Status Appeal Rights Case to Proceed

By | PRESS RELEASE | No Comments

Feb. 10, 2017 – In a decision released on February 8, 2017, a federal judge allowed Medicare hospital patients seeking a right to appeal their placement on “outpatient observation status” to proceed with their lawsuit. The Barrows case, now called Alexander v. Cochran, is a proposed nationwide class action brought by individuals who were forced to pay up to $30,000 for post-hospital skilled nursing facility care because they had been classified as outpatients in observation status during their hospitalizations.

Although care provided to patients on observation status is indistinguishable from inpatient care, it does not count toward the three-day inpatient hospital stay requirement for Medicare coverage of nursing home care. This leaves beneficiaries with the burden of paying for extremely costly nursing and rehabilitative care themselves – or forces them to forgo necessary care.

The court addressed whether Medicare beneficiaries have a constitutionally protected interest in coverage of their hospitalizations as inpatients rather than as observation “outpatients.” If such an interest exists, beneficiaries could appeal their observation status through Medicare’s administrative review process, which they are presently not allowed to do.

The opportunity to appeal is critical because of the severe ramifications that can result from the observation status categorization. The late Martha Leyanna of Delaware, for example, had to pay thousands of dollars to a nursing home because her six-day hospitalization was classified as observation status and thus did not meet Medicare’s requirement of a three-day inpatient stay for coverage of post-hospital care.

The decision documents the plaintiffs’ evidence of how Medicare pressures hospitals, through audits and enforcement actions, to place more patients on observation status, and describes the dogged but unsuccessful efforts of individual plaintiffs to appeal by calling numerous offices and Congressional representatives.

Judge Michael P. Shea of the U.S. District Court of Connecticut concluded that genuine factual disputes remain about the extent to which commercial screening guides used by Medicare contractors and hospitals influence the outcome of patient status determinations. The judge also largely denied the government’s request to dismiss the case on two other grounds, allowing the case to proceed.

Alice Bers of the Center for Medicare Advocacy, lead counsel for the plaintiffs, said “The decision is an important step in the establishment of a fair process for patients who risk having to pay thousands of dollars for necessary medical care or forgo that care altogether. Hospitals routinely appeal Medicare’s determination of whether a stay was inpatient or observation status. Older adults and people with disabilities who rely on Medicare for necessary health care should have the same right.”

In addition to attorneys from Justice in Aging, the plaintiffs are represented by attorneys from the Center for Medicare Advocacy, and the law firm of Wilson Sonsini Goodrich & Rosati. The court ordered the parties to confer and submit a schedule for further proceedings by February 22, 2017.

Justice in Aging is a national non-profit legal advocacy organization that fights senior poverty through law. Formerly the National Senior Citizens Law Center, since 1972 we’ve worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency. Through targeted advocacy, litigation, and the trainings and resources we provide to local advocates, we ensure access to the social safety net programs that poor seniors depend on, including Medicare, Medicaid, Social Security, and Supplemental Security Income (SSI).

# # #

Contact: Vanessa Barrington
510-256-1200 direct
vbarrington@justiceinaging.org