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Katrina Cohens

California Plaintiffs Win Case Against State for Failing to Provide Federally-Mandated In-Home Supportive Services

By | CA Health Network Alert, In-Home Supportive Services, PRESS RELEASE

State must reimburse or pay Medi-Cal recipients and conduct statewide outreach to thousands of Californians who may be eligible for in-home services

LOS ANGELES — Thousands of Medi-Cal beneficiaries with significant disabilities will now be able to access affordable Medi-Cal care at home, rather than going to a nursing facility. In-home care provides greater stability and health outcomes for individuals and families, and it is cost-effective for the state; but it can be prohibitively costly to pay for out-of-pocket. As a result, married people with disabilities often have to make a draconian choice: impoverish themselves and their spouses or go to a nursing facility.

“My wife and I live primarily on a fixed income of pensions and social security; we exhausted our life savings and retirement accounts paying for my care,” said plaintiff Patrick Kelley, a 68-year-old U.S. Army veteran living with spastic quadriparesis. “My wife’s ability to work was severely limited by her caregiving responsibilities to me. We spent almost all of her limited income paying for my in-home care.”

Thanks to the successful lawsuit against the state, married people with disabilities will now learn about their right to Medi-Cal eligibility so they can stay at home with their spouse, receive care, and be reimbursed through the state’s Medi-Cal program for In-Home Supportive Services (IHSS). The court ruling makes it clear that the state must fully implement a federal law, known as the expanded spousal impoverishment protection, which should have been implemented as part of the Affordable Care Act in 2014.

“This ruling will dramatically improve the quality of life for disabled Californians and their family caregivers and will prevent many Californians from falling into poverty due to the high cost of in-home care,” said Kim Selfon, IHSS Client Advocate at Bet Tzedek. “Caregivers selflessly care for their disabled spouses with courage and compassion, often to the detriment of their own finances and health. They and thousands of others will now have the support they need to continue caring for their loved ones at home.”

The two plaintiffs’ situations illustrate the diversity of the thousands of individuals that will be impacted by the outcome of this case.

“The judge’s decision is a boost to Welfare and Institutions Code section 10500, which says agencies must secure for every person the aid to which they are entitled. As California’s population ages, in-home care will become increasingly important to the future of the state,” said attorney Cori Racela of Western Center on Law & Poverty.

Plaintiff Matthew Reed is a 63-year-old man with multiple sclerosis, Bell’s Palsy, and vascular dementia from a stroke. Due to the severity of his disabilities and medical condition, Mr. Reed is eligible for Medi-Cal home services, and should have had access to care without out-of-pocket costs under spousal impoverishment protections. Instead, he was required to pay more than $1,500 per month for care, which he cannot afford.

“If the spousal impoverishment rule had been implemented as it should have, Matthew could have been found eligible for free Medi-Cal and IHSS,” said Matthew Reed’s wife, Vicki Reed. “That means my son or I could have earned IHSS wages, sparing us incalculable stress and anxiety and giving us better options for Matthew’s home care and more financial resources. I don’t want any other families to go through what we have gone through.”

The Affordable Care Act set a deadline to expand spousal impoverishment protections to home-based care starting January 1, 2014. However, the Department of Health Care Services (DHCS) failed to issue any guidance about the rule until July 2017, after Mr. Kelley and Mr. Reed brought this lawsuit.

The ruling in Patrick Kelley & Matthew Reed v. California Department of Health Care Services, et. al., was issued by a Los Angeles Superior Court judge on January 14, 2020. It concludes that DHCS must a) notify beneficiaries who could benefit from the rule, particularly those denied or discontinued from Medi-Cal because DHCS failed to implement the rule on time; b) create a process for people to be found eligible for IHSS retroactively to the date they applied for Medi-Cal; and c) allow impacted individuals to be paid for home services they were entitled to during the delay period.

“Choosing between remaining at home without needed services, impoverishing oneself and one’s spouse, or moving into a facility separate from loved ones is no choice at all,” said Claire Ramsey, Senior Staff Attorney at Justice in Aging. “This ruling means relief for many who have struggled to stay at home and in their community and receive the services they need.”

Bet Tzedek is committed to providing free legal services to those that need them most. Bet Tzedek attorneys and advocates help people of all communities and generations secure life’s necessities. Wherever people are in crisis, Bet Tzedek’s core services and rapid response programs provide stability and hope. Founded in 1974, Bet Tzedek – Los Angeles’ House of Justice – helps over 50,000 people each year.

Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. Since 1972 we’ve focused our efforts primarily on fighting for people who have been marginalized and excluded from justice, such as women, people of color, LGBTQ individuals and people with limited English proficiency.

Disability Rights California (DRC) is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to advance the rights, dignity, equal opportunities, and choices for all people with disabilities.

Western Center on Law & Poverty fights for justice and system-wide change to secure housing, health care, racial justice and a strong safety net for low-income Californians. Western Center attains real-world, policy solutions for clients through litigation, legislative and policy advocacy, and technical assistance and legal support for the state’s legal aid programs. Western Center is California’s oldest and largest legal services support center.

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

Justice in Aging Joins Amicus Brief Urging the Supreme Court to Defend the ACA

By | Health Care, Medicaid, Medicare, PRESS RELEASE

On January 15, Justice in Aging joined AARP and the Center for Medicare Advocacy in submitting an amicus brief urging the U.S. Supreme Court to expedite its review of a case challenging the constitutionality of the Affordable Care Act (ACA). The brief argues that the uncertainty caused by the Fifth Circuit’s decision to remand the case to the district court is harming older adults and that declaring the entire ACA unconstitutional will cause millions of older adults to lose health insurance coverage and vital consumer protections.

Several states led by Texas, along with the U.S. Department of Justice, are asking the courts to declare the entire ACA unconstitutional because Congress zeroed out the tax penalty for not complying with the law’s individual mandate to have health insurance. A federal district judge agreed and issued a ruling that the entire ACA is unconstitutional in December 2018. On appeal, the Fifth Circuit decided that the individual mandate without a penalty is unconstitutional, but remanded the decision back to the district court to review the ACA provision-by-provision to determine whether each is viable without the mandate.

Our amicus brief, filed in support of the states and the U.S. House of Representatives who are defending the ACA, demonstrates how the ACA’s critical protections and coverage expansions have improved the health and well-being of older adults, and how invalidating the ACA would disrupt the entire health care system, undermine the Medicare and Medicaid programs, and harm low-income seniors and their families. As explained in our statement on the Fifth Circuit’s decision and in our issue brief on the importance of the ACA to low-income older adults, millions of older adults and people with disabilities are alive and healthier today because the ACA enabled access to health care they couldn’t otherwise obtain.

Because of the ACA:

  • The lives of over 19,200 older adults on expanded Medicaid have been saved.
  • Seniors and people with disabilities have more opportunities to age in place and live at home, in their communities, where they want to be.
  • There is more care coordination for individuals who are dually eligible for Medicare and Medicaid and better protections for the lowest-income seniors from illegal billing for Medicare cost-sharing.
  • Seniors have stronger protections from discrimination and a new avenue for enforcing their civil rights.
  • Medicare beneficiaries have better access to preventive services and prescription drug coverage.

If the Supreme Court is persuaded by our arguments and upholds the constitutionality of the ACA, 100 million Americans with pre-existing conditions and 13 million Americans enrolled in expanded Medicaid will be able to move on with their lives without fear of losing coverage. And we can continue to build on the progress we have made using the ACA’s tools to enhance care coordination and consumer protections for Medicare and Medicaid beneficiaries, end discrimination, and eliminate health disparities, and achieve Justice in Aging for all.

Fact Sheet: Coverage Changes for Opioid Treatment Services for Dually Eligible Individuals

By | FACT SHEET, Health Care, Medicaid, Medicare, REPORTS

As of January 1, 2020, Medicare Part B covers a new Opioid Treatment Program (OTP) benefit. This means Medicare beneficiaries now have access to methadone for medication-assisted treatment (MAT) in an out-patient setting, along with counseling and other opioid use disorder (OUD) treatment services delivered by a certified OTP provider.

For individuals dually eligible for Medicare and Medicaid, this new coverage means that Medicare is now the primary payer for these OUD treatment services. The Centers for Medicare & Medicaid Services (CMS) has issued guidance to OTP providers, MA plans and to states to help ensure that dually eligible individuals who are currently receiving these OUD treatment services do not experience interruptions in care.

Justice in Aging’s new fact sheet describes the new OTP benefit and how it affects dually eligible individuals access to treatment for OUD. Advocates working with dually eligible individuals or other Medicare beneficiaries receiving or in need of OUD treatment services should become familiar with these changes to help clients navigate and identify any issues.

For example:

  • OTP providers and MA plans are prohibited from billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost-sharing for OTP services. In addition, all people enrolled in Original Medicare should not pay any cost-sharing for OTP services once they have met their Part B deductible.
  • States, MA plans, and providers should be following guidance to ensure continuity of care for dually eligible beneficiaries who are currently receiving OTP services.
  • State Medicaid programs cannot exclude or deny coverage of transportation (NEMT) for dually eligible individuals to Medicare-covered benefits, including OTP services.

Please let us know if you observe any issues with these changes in Medicare coverage of OUD treatment services. Your feedback helps us identify systemic issues and work with CMS to resolve them.

Free Webinar: What’s Next for California’s Dual Eligibles? CalAIM and the Coordinated Care Initiative

By | CA Health Network Alert, Health Care, Medicaid, Medicare, WEBINAR, Webinar Trainings

When: Thursday, January 16, 2020 from 10 a.m.-11 a.m. PT/1-2 p.m. ET

In 2014, California’s Department of Health Care Services launched the Coordinated Care Initiative for dual eligibles in certain counties. It provided dual eligibles with an option to enroll in an integrated Medicare-Medicaid plan called Cal MediConnect. Now, California has proposed ending Cal MediConnect and transitioning to a statewide Dual Special Needs Plan (DSNP) model with managed Long-Term Services and Supports (MLTSS). It is also proposing changes to the Medi-Cal Long-Term Care benefit and the Multipurpose Senior Services Program (MSSP) and requiring dual eligibles to enroll in Medi-Cal managed care across the state. This webinar will unpack the major proposed changes that affect dual eligibles, including:

  • A brief overview of the Coordinated Care Initiative and Cal MediConnect;
  • Discussion of the major components of the CalAIM proposal that impact dual eligibles, including the D-SNP transition, mandatory Medi-Cal managed care enrollment, and changes to long-term care and MSSP, and what these changes mean to counties in and out of the Coordinated Care Initiative;
  • Areas that are ripe for advocacy based on the CalAIM proposal; and
  • How advocates and other stakeholders can provide input on the proposed changes.

Who should participate:
Advocates who work with California’s dual eligibles, individuals interested in California’s dual eligible demonstration, and other stakeholders.

Presenter:
Denny Chan, Senior Staff Attorney, Justice in Aging

This webinar took place on Thursday, January 16, 2020, from 10 a.m.-11 a.m. PT/ 1-2 p.m. ET. 

Closed captioning will be available during this webinar. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webinar start time. 

REGISTER FOR THE WEBINAR

Executive Director Kevin Prindiville’s Statement on ACA Ruling

By | PRESS RELEASE

Below is a statement from Justice in Aging’s Executive Director Kevin Prindiville on yesterday’s ruling on the Affordable Care Act by the 5th Circuit Court of Appeals.

Yesterday, the 5th U.S. Circuit Court of Appeals ruled that the Affordable Care Act’s individual mandate is unconstitutional, and remanded the case to the District court to clarify whether the rest of the ACA can stand without the mandate. For now, the ACA remains in place without the mandate, but, if the law is invalidated, the health of millions of older Americans and their families is at risk.

The ACA is a lifeline for older adults and people with disabilities. If the ACA is ultimately found unconstitutional, 100 million Americans with pre-existing conditions and the 20 million people who gained coverage through Medicaid expansion would face higher health care costs or lose access to coverage entirely. Populations of color who saw the greatest coverage gains under the ACA would be particularly harmed.

District Court Judge Reed O’Connor, who previously ruled that the entire ACA should be struck down, is unlikely to make a different decision a second time. Rather, today’s decision only serves as a delay, causing uncertainty, fear, and disruption in the current health insurance market and in the lives of older adults, their families, and all Americans.

Issue Brief: Qualified Medicare Beneficiary (QMB) Protections in Medicare Advantage: Issues, Tips and Avenues for Advocacy

By | Health Care, ISSUE BRIEF, Medicare, REPORTS

The Qualified Medicare Beneficiary (QMB) program is a Medicaid benefit that pays for Medicare premiums as well as protects individuals from coinsurance and copayment for Medicare-covered services. QMB protections apply whether a beneficiary receives Medicare through Original fee-for-service Medicare or a Medicare Advantage plan.

A new Justice in Aging issue brief, Qualified Medicare Beneficiary (QMB) Protections in Medicare Advantage: Issues, Tips, and Avenues for Advocacy, looks at how QMB protections apply to beneficiaries enrolled in Medicare Advantage plans and discusses ways advocates can address common issues that arise for QMB beneficiaries in Medicare Advantage. It also identifies areas for advocacy to make Medicare Advantage work more smoothly for QMBs.

House Passes Groundbreaking Drug Pricing Legislation that Adds a Dental Benefit to Medicare & Protects Low-Income Seniors

By | Medicare, NEWS

Yesterday, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3). This legislation takes on meaningful drug pricing reform to make momentous improvements to the Medicare program, protect low-income seniors and people with disabilities, and help older adults and families across America afford their medications.

By empowering the Secretary of Health & Human Services to negotiate drug prices on behalf of the Medicare program, H.R. 3 would make prescription drugs more affordable and generate over $450 billion in savings. The bill reinvests those substantial savings in Medicare to provide 60 million seniors and people with disabilities with dental, vision, and hearing services for the first time in the program’s nearly 55-year history. These are tangible and greatly needed benefits that will help reduce health disparities. For example, nearly 2 out of 3 people with Medicare do not currently have any dental coverage and staggering numbers have not been to a dentist in the past year: 71% of black beneficiaries, 65% of Hispanic beneficiaries, 62% of beneficiaries under age 65 with disabilities, and 59% of beneficiaries living in rural areas.

H.R. 3 would also make important progress towards better ensuring Medicare beneficiaries with limited income and resources can afford to use their coverage. It expands the Qualified Medicare Beneficiary program to individuals with incomes up to 150% of the federal poverty level and expands the Part D Low-Income Subsidy (LIS) to individuals with incomes up to 200% of the federal poverty level. These expansions would save beneficiaries thousands of dollars each year, easing their budgets and helping them keep a roof over their head and food on the table.

Read more about what H.R. 3 does to improve access to Medicare for low-income older adults and people with disabilities in our letter of endorsement.

FAQ: Adding a Dental Benefit to Medicare Part B

By | FACT SHEET, Health Care, Medicare, Oral Health, REPORTS

As Justice in Aging has been engaged in advocacy to add an oral health benefit to Medicare Part B, we’ve received a number of questions from advocates and others about how older adults currently access oral health benefits, what coverage the various parts of Medicare offer, and what adding an oral health benefit to Medicare Part B would look like.

We created a new resource, Adding a Dental Benefit to Medicare Part B: Frequently Asked Questions, to answer these common questions.

Fact Sheet: Open Enrollment for 2020 Coverage through Medicare & Covered California—Basics for Advocates

By | Affordable Care Act, CA Health Network Alert, FACT SHEET, Health Care, Medicare, REPORTS

Justice in Aging has updated our California fact sheet that provide the essential information advocates for older adults need to know about this year’s open enrollment periods for both Medicare and the Affordable Care Act Marketplaces. Changes consumers make to either their Medicare or Marketplace coverage during open enrollment will take effect January 1, 2020.

Fact Sheet: Open Enrollment for 2020 Coverage through Medicare & the Marketplace—Basics for Advocates

By | Affordable Care Act, FACT SHEET, Health Care, Medicare, REPORTS

Justice in Aging has updated our national fact sheet that provide the essential information advocates for older adults need to know about this year’s open enrollment periods for both Medicare and the Affordable Care Act Marketplaces. Changes consumers make to either their Medicare or Marketplace coverage during open enrollment will take effect January 1, 2020.