Category

CA Health Network Alert

FAQ: Part D Drug Co-Pays and Refunds for Certain California Dual Eligibles

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

In 2012, the Affordable Care Act expanded the Part D Extra Help Program, also known as the Low-Income Subsidy (LIS), so that dual eligibles enrolled in certain Home and Community-Based Services (HCBS) should not be charged any co-pays for Part D covered drugs. However, since 2012, some California duals enrolled in Community-Based Adult Services (CBAS) and in San Mateo’s Multipurpose Senior Services Programs (MSSP) have been improperly charged co-pays. The Centers for Medicare & Medicaid Services (CMS) and California’s Department of Health Care Services (DHCS) is beginning to work with Part D and Medicare Advantage plans so that these dual eligibles are properly assessed co-pays and retroactively reimbursed for any improper amounts collected.

Justice in Aging created an FAQ for advocates to answer key questions about the implementation of these refunds.

California’s Master Plan For Aging: Address Senior Hunger by Maximizing CalFresh and the Hold Harmless Food Benefits

By | CA Health Network Alert, FACT SHEET, REPORTS, SENIOR POVERTY

California has committed to developing a Master Plan for Aging in order to meet the needs of older adults today and for generations to come.

The third in this series of papers, Addressing Senior Hunger by Maximizing CalFresh and the Hold Harmless Food Benefits, offers specific policy recommendations for addressing troubling senior hunger trends, and the low utilization among seniors of available benefits.

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

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

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.

Advocates Guide: In-Home Supportive Services (IHSS)

By | Advocate's Guide, CA Health Network Alert, In-Home Supportive Services, REPORTS

The In-Home Supportive Services (IHSS) program is a Medi-Cal program in California that pays for in-home care for people with disabilities, including children, adults, and seniors. The purpose of this vital program is to provide services and supports that help people remain safely in their homes and living in the community.

Justice in Aging is releasing a new Advocates Guide about the IHSS program for advocates and individuals who provide assistance to older adults, children, and adults with disabilities. Written with significant support from Disability Rights California, the guide provides in-depth information about the IHSS program and is divided into eight chapters:

  • IHSS Program Overview;
  • Eligibility and Applying for IHSS;
  • Medi-Cal Programs and IHSS;
  • IHSS Services Overview;
  • Types of Services;
  • IHSS Providers;
  • Post-Eligibility Issues;
  • and Appeals and Hearings.

New Budget Boosts Health Coverage For Low-Income Californians

By | CA Health Network Alert, Health Care, IN THE NEWS, Medicaid, Medicare, Social Security

Kaiser Health News: New Budget Boosts Health Coverage For Low-Income Californians (June 25, 2019)

California’s new state budget for 2019-20 includes funds that will help about 25,000 low income older adults and people with disabilities get full Medi-Cal coverage. In the past, older adults had to meet stricter requirements to qualify for Medi-Cal than adults under 65. Regarding the past eligibility rules, Justice in Aging’s Directing Attorney Amber Christ said, “We call this the senior penalty, because basically you’re being penalized with a stricter eligibility limit based fully on your age or disability.” The new budget will also restore five areas of Medi-Cal coverage: audiology, optical services, podiatry, incontinence supplies and speech therapy.

Principles of a Master Plan on Aging for all Californians

By | CA Health Network Alert, Safety Net Defense, SENIOR POVERTY, Statements

In January, Governor Newsom called for a Master Plan on Aging in his State of the State address, and concurrently members of the legislature introduced several bills aimed at addressing California’s growing aging population. The need is urgent as California’s population ages and grows poorer. California’s population of older adults is expected to almost double over the next twenty years. Today, one in five seniors in California live at or below the poverty level, with women and populations of color experiencing poverty at higher rates. Without a dedicated plan and resources to address California’s aging population, many more older adults will fall into poverty in their later years.

As lawmakers work to revise the 2020 budget this month, we urge them to direct funding toward a comprehensive Master Plan that addresses the struggles of the poorest Californians, is centered on equity, makes provision for a robust long-term care system, and is both intergenerational and intersectional.

We laid out a set of principles that we urge policymakers to consider and incorporate in the Master Plan to help those Californians who are struggling the most, and also middle class older adults, families, and all of our communities. We have the political momentum to address the needs of California’s aging population. This is a once-in-a-generation opportunity to get it right and help all Californians age in dignity and justice.

Read the principles.

Fact Sheet: Seniors and People with Disabilities Who Receive SSI Can Apply for CalFresh in Summer 2019

By | CA Health Network Alert, Economic Security, FACT SHEET, REPORTS, Supplemental Security Income

Due in part to advocacy from groups like Californians for SSI, the 2018-2019 state budget included a policy change allowing California seniors and people with disabilities who receive SSI to be eligible for CalFresh (SNAP) benefits starting June 1, 2019.

Access to federal SNAP nutrition assistance will increase food security for California’s low-income SSI seniors and people with disabilities, leading to fewer people being forced to choose between basics like food and medicine, and giving people more flexibility to direct money toward other needs such as finding and being able to afford housing. The expansion will be particularly important for seniors age 60 or older, who represent more than half of the over 1.2 million low-income Californians who receive SSI to help meet their basic needs.

Aging services providers can learn more details about this important and historic change in a new fact sheet from Justice in Aging. The five-page fact sheet helps providers understand the details of the change in order to better support their clients. The fact sheet also includes information on CalFresh rules that will be particularly relevant for enrolling SSI seniors and people with disabilities this summer and beyond.

A Dental Benefit in Medicare: Examining the Need in California

By | CA Health Network Alert, IN THE NEWS, Medicare, Oral Health

California Dental Association: A Dental Benefit in Medicare: Examining the Need in CA (copyright April 2019)

Justice in Aging’s Executive Director Kevin Prindiville and Director of Health Team Amber Christ co-authored this paper that discusses the oral health care need of California’s older adults. Lack of access to affordable and comprehensive dental coverage has resulted in California’s older adults having a high prevalence of oral disease. The addition of a comprehensive dental benefit to Medicare Part B would help lower the rates of oral disease.