A new Justice in Aging fact sheet details how they can enroll in the Qualified Medicare Beneficiary (QMB) Program to get their Medicare premiums paid through their state Medicaid program. Enrolling in QMB can be confusing for people without Part A coverage and often requires visits to both the Social Security Administration office and the state’s Medicaid program offices. A further complication is that many Social Security offices have used conflicting and incorrect procedures or provided misinformation to applicants. Read More
States require managed care plans who serve Medicaid enrollees to establish and maintain an internal grievance and appeal and fair hearing system. As states begin to incorporate new federal regulations into their Medicaid rules, there’s opportunity for advocates to help shape those rules to ensure that older adults and people with disabilities have equal access to the grievance and appeal and state fair hearing systems, as mandated by Section 504 of the Rehabilitation Act (“Rehab Act”), the Americans with Disabilities Act (“ADA”), and Section 1557 of the Affordable Care Act (“ACA”).
Disability Rights Education and Defense Fund (DREDF), Justice in Aging and National Health Law Program (NHeLP) collaborated on a new Advocates Guide to Accessibility in Medicaid Managed Care Grievances, Appeals, and State Fair Hearing. This new Advocates’ Guide, provides guidance on how the federal framework can be made fully accessible to Medicaid beneficiaries who are older and/or have disabilities.
Links to three accessible versions of the guide can be found below.
Oral health is an integral part of overall health. Oral health problems can adversely affect one’s ability to maintain optimal nutrition, self-image, social interactions, and mental and physical health. Oral health problems can lead to chronic pain, tooth loss and serious infections. Poor oral health can even worsen chronic medical conditions such as heart disease and diabetes.
Older adults need timely and affordable access to dental care in order to maintain their health and well-being, yet, there is currently no mechanism for most older adults to access care. Contrary to what many believe, Medicare does not include an oral health benefit. Most older adults cannot afford to purchase private oral health insurance or pay out-of-pocket for the care they need. As a result, 70 percent of Medicare recipients have limited or no dental coverage, and fewer than half see a dentist each year.
A new White Paper, An Oral Health Benefits in Medicare Part B: It’s Time to Include Oral Health in Health Care discusses how a Medicare Part B dental benefit would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education. The paper also details how such a benefit could be structured and the legislative changes that would need to happen before such a benefit could be established.
New Advocacy Guide: Oral Health for Older Adults in California
Oral health affects overall health – this is particularly true for older adults. Yet, access to oral health treatment is limited and complicated by factors such as lack of dental coverage, complicated rules, and lack of dental providers. To assist California advocates in connecting their clients with oral health treatment, Justice in Aging has developed an Advocacy Guide for Oral Health for Older Adults in California.
The Guide includes a summary with advocacy tips on the following topics:
- Why oral health matters
- The state of oral health for older adults in California today
- Health insurance coverage options for older adults including Medicare, Denti-Cal, and other forms of coverage
- Unique barriers sub-populations of older adults encounter in accessing oral health including dual eligibles and nursing facility residents
- Treatment alternatives for individuals without dental coverage
- Additional resources
It is our intention that this Guide will help advocates navigate the system and empower them to identify and address systemic barriers to care.
Visit Justice in Aging’s Oral Health page for additional resources and help us celebrate #OralHealthMonth by forwarding this resource to your networks.
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.