The Centers for Medicare & Medicaid Services issued guidance allowing states to condition Medicaid eligibility on fulfilling work and “community engagement” requirements. Under this policy, states can require adults to work in order to receive Medicaid if they are under age 65 and not disabled under the Social Security Administration’s strict definition. Although states are required to exempt some individuals who cannot work based on their health conditions, and encouraged to allow caregiving hours to count as work, all of these individuals will still be subject to onerous reporting requirements. This presents a significant barrier to health care access for many of the nearly 9 million adults ages 50 to 64 who rely on Medicaid, as well as nearly 5 million people with disabilities and chronic health conditions who do not receive Social Security Disability or Supplemental Security Income, and family caregivers. Learn more with our factsheet!
Older adults and their families strive each day to pay for health care and medicine, keep food on the table, have a roof over their heads, and have enough cash on hand to pay the utilities, get where they need to go and meet other basic needs. As families work together to meet these challenges, they are supported by a broad range of federal programs that provide Americans with the means to thrive as they grow older and remain at home and in their communities.
This issue brief discusses how these various programs work, who is eligible for them, and how they support the health and economic well-being of older Americans. For a quick overview, check out the fact sheet.
Why do some individuals receiving Supplemental Security Income (SSI) benefits only receive $500 a month instead of $750? In many cases, the reason is “in-kind support and maintenance” (ISM).
As SSI is a means-tested program, applicants and recipients must meet several financial eligibility criteria on an ongoing basis. The income and resource rules, including in-kind support and maintenance, are particularly complicated. These rules can cause significant hardship for low-income people trying to survive on SSI.
This new guide, In-Kind Support and Maintenance in the SSI Program, gives advocates tools to successfully navigate ISM on behalf of their clients. They can make a big difference by making sure that clients can maximize their SSI benefits to better meet their needs for shelter, food, health care, and other necessities.
Supplemental Security Income (SSI)—a need-based program administered by the Social Security Administration – provides a very basic income to over 8.2 million people, including 2.2 million seniors age 65+. As more seniors struggle to make ends meet in today’s economy, getting access to SSI can help low-income seniors escape deep poverty and avoid or move out of homelessness. Justice in Aging’s Supplemental Security Income 101: A Guide for Advocates introduces advocates and individuals who provide assistance to older adults to the SSI program and focuses on the basics of the program for those who qualify based on age (65 years or older).
Released today, the Guide includes:
- A description of the SSI program and benefits
- An overview of the application and appeals processes
- A discussion of key eligibility criteria, including examples
Federal law prohibits charging Qualified Medicare Beneficiaries (QMBs) with Medicare cost-sharing for covered services. Depending on state law, other beneficiaries who are fully eligible for both Medicare and Medicaid–full benefit dual eligibles–may also be protected from being billed for co-payments or other forms of cost sharing.
However, QMBs and other dual eligibles may still be responsible for certain charges or fees. A new Justice in Aging Issue Brief: Advance Beneficiary Notices, Administrative Fees, and Dual Eligibles explains for advocates the situations under which these types of beneficiaries may be responsible for charges.
Read the brief to learn what protections QMBs have and what charges they may have to pay.
Additional Justice in Aging resources on improper billing can be found here.
On February 9, Congress passed the Bipartisan Budget Act of 2018 (BBA of 2018). In addition to its budget provisions, the BBA extends and makes changes to several Medicare programs and provides funding for other health programs that support low-income older adults, people with disabilities, and their families.
Justice in Aging has prepared a summary of some of the major health provisions in the BBA of 2018, including funding for Community Health Centers and outreach to low-income Medicare beneficiaries, the Medicare therapy cap repeal, Part D “donut hole” closure, and authorization of Special Needs Plans and other Medicare Advantage changes. As these changes are implemented, Justice in Aging will continue to provide updates and analysis and identify advocacy opportunities.
A representative payee is a third party who is authorized to receive and manage Social Security payments for a beneficiary who isn’t able to do so for themselves. Often, a creditor, such as a nursing facility or other residential facility can be appointed by the Social Security Administration (SSA) to act as a representative payee. When creditors perform this function, conflicts can arise and there must be adequate consumer protections in place to protect the best interests of the beneficiary and the Social Security system.
A new Justice in Aging issue brief, Skilled Nursing Facilities and Other Creditors Acting as Representative Payees, dives into some of the conflicts that can arise and proposes ways to strengthen the oversight and protections within the representative payee system.
The Coordinated Care Initiative (CCI)—including California’s dual eligible demonstration project Cal MediConnect—is well underway in all seven CCI counties including Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. There have been significant changes to the CCI since the release of Version Five of Justice in Aging’s Advocates Guide to California’s Coordinated Care Initiative in October 2016.
Released today, Version Six of the Guide includes:
- A description of new and updated CCI policies
- Additional advocacy tips
- Evaluation results and new resources
If you have saved or printed Version Five, please replace it with Version Six, because the former now contains outdated information.
If you missed the webinar, Coordinated Care Initiative: 2017 Update, the video is now available.
On October 2, 2017, the Centers for Medicare and Medicaid Services (CMS) initiated changes in the Provider Remittance Advice and the Medicare Summary Notice (MSN) to show more clearly that Qualified Medicare Beneficiaries (QMBs) may not be charged for Medicare deductibles and co-insurance. Unfortunately, CMS will be temporarily suspending these system changes as of December 8 because of significant unforeseen issues affecting provider payments. CMS is working to address the problem and reinstate the new systems sometime in 2018.
The temporary suspension of the system improvements does not affect the rights of QMBs. QMBs do not owe deductibles and co-insurance for any Medicare Part A or Part B services.
The suspension also does not affect another change, instituted in November, that enables providers to confirm QMB eligibility before serving individuals, using the same systems through which they check other insurance coverage.
To learn more about these developments, read our fact sheet.
For more information on QMB protections, see the CMS QMB Program webpage. For tools that advocates can use to assist QMB clients who have been improperly billed, go to Justice in Aging’s Improper Billing page.
Republican leadership in both the Senate and House are pushing forward on tax proposals that would give a huge tax break to the wealthiest Americans and corporations and allow Congress to pay for it by cutting funding for critical programs needed by everyone else.
The Senate is expected to vote this week on its version of the plan.
Both Senate and House bills would explode the deficit and make it harder for older adults to afford health care—all while benefitting the wealthiest 1% and big corporations. We created a new fact sheet, Republican Tax Bills Will Hurt Older Adults, for advocates to use this week in their advocacy. The fact sheet outlines how exploding the deficit will force cuts to programs and health coverage for older adults, and how the wealthy 1% and corporations will benefit at the expense of older adults. Please use this fact sheet in your conversations with partners and policy makers and share widely.
Now is also the time to call your Senators and tell them to vote NO on this tax plan. Dial 202-224-3121 and ask to be connected.
Today, Justice in Aging and Center for American Progress are holding a joint briefing on what the tax bills mean for seniors. There’s also a National Call-in Day on Wednesday focused on people with disabilities and their families.