MSPs currently reach over 7 million people with Medicare. Many are too poor to afford Medicare but do not qualify for other Medicaid programs. This issue brief discusses how the program is structured and administered and outlines how cuts in Medicaid could force cuts to the program. Read More
On Thursday, June 22, 2017, Senate Republicans revealed the Better Care Reconciliation Act of 2017, their version of the American Health Care Act (AHCA) that was passed by the House last month, and was intended to repeal and replace the Affordable Care Act.
Our new Issue Brief, Health Care on the Chopping Block: How Older Americans Will Suffer Under Senate Republicans’ Proposal to Cap Medicaid Funding, provides a detailed description of how Medicaid is currently funded, what the bill proposes, and how the cuts will play out for older adults.
Our new issue brief Cuts to Multi-Recipient Households Push Older Adults & Their Families Deeper into Poverty outlines who’s most affected and discusses how these cuts would discourage families with older adults and people with disabilities from helping one another out by sharing their homes.
The cuts would push already poor families deeper into poverty, force people onto the streets or into institutions, and result in costly administrative burdens for the Social Security Administration (SSA).
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.
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.
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.
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.
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.
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.
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.