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.

Fighting Improper Billing of Dual Eligibles: New Strategies


Doctors, hospitals, and other providers often bill dual eligible Medicare beneficiaries and Qualified Medicare Beneficiaries (“QMBs”) for services that should be covered under Medicare or Medicaid. This practice of improper billing is illegal and can cause low-income beneficiaries to go into debt, skip needed medical care, or end up without sufficient funds to pay for necessities like food and rent.

Justice in Aging has created several new resources that advocates can use to stop providers from billing their clients improperly. Today we’re releasing all of our improper billing resources together as a toolkit on our website. In the Improper Billing Toolkit, you’ll find a new issue brief including a chart of improper billing regulations organized by state, several model provider letter templates, including California-specific letters, all of the trainings we have presented on the topic, as well as resources from CMS on improper billing.

Improper billing of QMBs has been a persistent problem across the country that Justice in Aging and other advocates have been working to stop. We’ve worked with CMS to improve its provider education efforts and internal processes, and provided advocates with previous trainings and resources. We’ve made progress but more remains to be done.

That’s why we created this robust toolkit for you to use to help your clients and to share broadly with other advocates.

Medicaid Funding Caps Would Harm Older Americans

By | Health Care, ISSUE BRIEF, Medicaid, REPORTS | No Comments

Recent months have seen increased discussion of proposals to cap federal Medicaid spending. Under these proposals, the federal government would provide limited funding through either block grants or per capita payments to states, and states would have broad discretion to set their own Medicaid standards.

A new issue brief from Justice in Aging explains how these proposals would harm older Americans. The caps would result in a dramatic reduction in federal funding for Medicaid, and these crippling cuts would be exacerbated by the loss of longstanding federal protections. Potential consequences include loss of services, cutbacks in eligibility, unaffordable health care costs, and diminished quality of care.

The issue brief provides careful analysis of both the “cap” proposals and the protections of existing Medicaid law. Many of the proposals tout the “flexibility” of giving almost complete discretion to states. As the issue brief highlights, however, consumer protections in current Medicaid law are vital to older Americans’ health and financial security.

Section 1557: Strengthening Civil Rights Protections in Health Care

By | Affordable Care Act, Health Care, ISSUE BRIEF, REPORTS | No Comments

So many health care protections are at risk in the months ahead, including Section 1557, the provision in the Affordable Care Act (ACA) that specifically applies civil rights protections to health care settings.

This ACA provision has already been targeted, as a nationwide preliminary injunction issued on December 31 by a Federal District Court in Texas prohibits the Department of Health and Human Services (HHS) from enforcing the provisions in the implementing regulations that pertain to transgender discrimination and discrimination based on termination of pregnancy. The temporary order leaves the rest of Section 1557 intact, although some in the new administration and the new Congress would like to go further, seeking to repeal Section 1557 as part of a broader ACA repeal effort.

Justice in Aging has prepared a brief summary of the extent to which the injunction is likely to impact programs that affect older adults.

Justice in Aging also created an issue brief that discusses how Section 1557 and the HHS implementing regulations affect programs that serve older adults. The brief looks at discrimination protections around language access for beneficiaries with limited English proficiency, sex and gender discrimination, disability discrimination and discrimination based on age and race, with examples of how those provisions could play out for older adults using the Medicare or Medicaid benefit.

Why the Recently-Revised Nursing Home Regulations are Vital for Nursing Home Residents

By | FACT SHEET, REPORTS | No Comments

Consumer protection is a critical part of federal oversight for nursing facilities. The federal government issued revised nursing facility regulations in September, and most provisions became effective on November 28. The regulations are the product of over four years of work by the Centers for Medicare & Medicaid Services, including significant modifications in response to public comments received in mid-2015.

The new fact sheet, Why the Recently-Revised Nursing Home Regulations are Vital for Nursing Home Residents, provides a quick overview of some of the important new provisions, so that stakeholders and policymakers can better understand the revised regulations’ important role in improving nursing facility care. The revised regulations provide many benefits to nursing facility residents, including an increased focus on addressing a resident’s needs and preferences.

This fact sheet was developed by Justice in Aging in partnership with The National Consumer Voice for Quality Long-Term Care.

Series: A Closer Look at the Revised Nursing Facility Regulations

By | FACT SHEET, REPORTS | No Comments

The federal government issued revised nursing facility regulations in September, and most provisions became effective on November 28. Now is the time for advocates, providers, and others to better understand how the regulations are changing nursing facility care.

Justice in Aging, in partnership with The National Consumer Voice for Quality Long-Term Care, and the Center for Medicare Advocacy, is developing a series of issue briefs on different aspects of the revised regulations, entitled A Closer Look at the Revised Nursing Facility RegulationsThe series kicked off with a Fact Sheet entitled, Why the Recently Revised Nursing Home Regulations are Vital for for Nursing Home Residents. 

The series of issue-specific briefs are available below:

Assessments, Care Planning, and Discharge Planning

Involuntary Transfer and Discharge

Unnecessary Drugs and Antipsychotic Medications

Nursing Services

Medicaid Non-Emergency Medical Transportation (NEMT): An Overlooked Lifeline for Older Adults


Low-income older adults depend on Medicaid’s non-emergency medical transportation (NEMT) benefit for transportation services to and from medical services. Nearly 7.1 million Americans rely on it. Yet, every year, an estimated 3.6 million Americans miss or delay health care because of difficulty accessing these critical services.

With our partners at Community Catalyst’s Center for Consumer Engagement in Health Innovation, we created an issue brief, Medicaid Non-Emergency Medical Transportation: An Overlooked Lifeline for Older Adults.

The brief outlines the importance of NEMT for older adults and people with disabilities, details the challenges faced by users, and offers a series of recommendations based on promising state practices.

For a quick overview of the full brief, visit our blog. You can also view the accompanying webinar here.


Medicaid Managed Care Tool

By | REPORTS | No Comments

The federal government published new Medicaid managed care regulations on May 6, 2016. The new regulations are extensive, and will affect every aspect of Medicaid coverage provided through managed care.  The new regulations will be phased in over time from 2016 through 2019.

Justice in Aging has developed this tool to assist advocates in using and analyzing the new regulations.  With this tool, you can search for regulations by section number, section title, the key issue the provision addresses, and effective date. The tool also provides a summary and background on each provision and offers advocacy tips where applicable.

Note: This tool includes all of the managed care regulations that are effective on or before July 5, 2016.  By mid-July 2016, the tool will be revised to include all of the managed care regulations, regardless of effective date.

Rating Periods: Many provisions are effective based on rating periods. Rating periods are the twelve month period for which capitation rates are developed under a managed care contract.

Plan(s): We employ the term “plan” as an umbrella term to include all managed care entities subject to the regulations including Managed Care Organizations (MCOs), Prepaid Inpatient Ambulatory Health Plans (PIHPs), Prepaid Ambulatory Health Plans (PAHPs), and Primary Care Case Management (PCCMs). If a provision applies to a certain type of managed care entity, we specify this in the summary and background. Read More

How SSA Can Improve the Representative Payee Program to Protect Vulnerable Seniors


Social Security’s Representative Payee Program is crucial to protecting the resources and economic security of vulnerable older adults who cannot manage their own finances. It is also inadequate to meet the growing needs of older adults and has a number of problems in both its capability determination process and in the way the overall program is administered. This Issue Brief, How SSA Can Improve the Representative Payee Program to Protect Vulnerable Seniors is the final paper in a series that Justice in Aging has produced with the support of a fellowship grant from the Borchard Foundation on Law and Aging.

You can access the full toolkit of publications on the Representative Payee Program here.

Voluntary Means Voluntary: Coordinating Medicaid HCBS with Family Assistance

Family caregivers in the U.S. provide billions of hours of care worth billions of dollars. This care should be voluntary, and, for older adults and people with disabilities receiving the care under a Medicaid service plan, federal law requires it.

Under federal Medicaid regulations, Medicaid service plans for older adults and people with disabilities who receive Home and Community-Based Services (HCBS) cannot compel family members to provide unpaid assistance. However, state Medicaid programs (often through managed care organizations) frequently violate federal law by basing service levels on the availability of unpaid care by family members, effectively compelling family members to provide this care, often at the expense of their jobs and their own health.

In this Issue Brief, Voluntary Means Voluntary: Coordinating Medicaid HCBS with Family Assistance, multiple examples from Florida illustrate this systemic national problem and point the way toward the advocacy needed to solve it.

Read More