Every January, many Medicare beneficiaries change their Part D prescription drug coverage. Even those who don’t switch may find that their current plans have made changes in the drugs they cover or the utilization management restrictions they impose.
State Medicaid programs increasingly are moving their long-term services and supports programs to managed care. But the transition is not without its potential pitfalls for Medicaid beneficiaries and their advocates.
Person-centered planning is now almost universally understood as a necessary component of an effective delivery system for long-term services and supports. Done well, person-centered planning can ensure greater independence and a better quality of life for consumers receiving LTSS. Ideally, consumers take an active, leading role in the planning process, armed with the information they need to make informed choices about services and supports that comport with their needs, as well as their preferences, goals, and desired outcomes. But there is still a lack of clarity about what exactly person-centered planning is and how to make sure it is delivered.
REPORT - ISSUE BRIEF
The Problem: Can You Spot the Legal Violations in this Job Announcement?
California’s assisted living policy is surprisingly behind-the-times. 30 years ago, the assisted living system was created in California for residents without significant health needs. Today, assisted living residents are much sicker than they used to be, but there’s no solid quality of care standards for the facilities to follow to meet this need within the law. This leaves facilities in the precarious position of trying to meet residents’ health care needs, like for medication administration, sometimes by finagling their own solution like hiring a “med tech” or “med aide” –terms not defined in California law and without state education and testing standards.
Read the full issue brief here, including a quick quiz on the surprising legal violations found in many assisted living job announcements.
Dual Eligibles in a number of California counties who are currently enrolled in either Medicare Advantage Plans or certain Duals Special Needs Plans (D-SNPS) may see their plans change and/or may be subject to passive enrollment in Cal MediConnect, depending on a number of factors. The California Department of Health Care Services (DHCS) released the new Duals Special Needs Plan (D-SNP) policy last summer for beneficiaries in Los Angeles, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara Counties, and more recently for Orange County.
To help advocates unravel the complex policy and better advise their clients, Justice in Aging developed a series of county-specific fact sheets summarizing for advocates how beneficiaries are impacted depending on the type of Medicare Advantage plan in which a beneficiary is enrolled.
Today, we are releasing the Orange County fact sheet for the first time, and rereleasing the other county-specific fact sheets.
January 2014 — An issue brief from the National Senior Citizens Law Center says that the Social Security Administration needs a uniform system in place to input and track appeals by Supplemental Security Income (SSI) recipients and to ensure that all requests for reconsideration are logged in upon receipt in a district office. It provides an overview of how those who have a legitimate basis for challenging benefit suspensions and reductions.
July 2013 — The Advocate’s Guide to California’s Coordinated Care Initiative helps advocates understand the Coordinated Care Initiative (CCI), a new state program changing the way dual eligible beneficiaries and other seniors and persons with disabilities get their health care in eight California counties.
The guide includes a description of the CCI, information on whom the CCI impacts, how individual beneficiaries are impacted, why it is being implemented and when and where the program is taking place.
The guide, which will be updated as program rules develop and change, includes a pull-out table that an advocate can use to determine who the CCI impacts and how it affects beneficiaries.
The National Senior Citizens Law Center and the Disability Rights Education and Defense Fund (DREDF) coauthored the guide.