Category

DUAL ELIGIBLES

Issue Brief: D-SNP Look-Alikes – A Primer

By | DUAL ELIGIBLES, ISSUE BRIEF, Medicaid, Medicare, REPORTS

More dual eligibles—individuals with Medicare and Medicaid—are enrolling in a certain type of Medicare Advantage plan as a result of aggressive marketing efforts targeting dual eligibles. This type of plan, known as a Dual Eligible Special Need Plan (D-SNP) Look-Alike, threatens to undermine promising advancements in integrated care for duals made possible by the Affordable Care Act (ACA). D-SNP look-alikes are not subject to the regulations governing D-SNPs and therefore have no responsibility to coordinate Medicare and Medicaid benefits. Because they are marketed aggressively almost exclusively to duals, they draw dual eligibles away from coordinated options and place responsibility on the consumer to navigate two separate delivery systems, potentially exacerbating disruptions and gaps in care.

Justice in Aging created this issue brief, Dual Eligible Special Need Plan Look-Alikes – A Primer, to help educate advocates working with dual eligibles about the impact of these plans on dual eligibles and to request that advocates report experiences with D-SNP look-alikes to Justice in Aging and CMS.

This new issue brief:

  • Outlines some key requirements of D-SNPs;
  • identifies the basic characteristics of D-SNP look-alikes;
  • discusses problems look-alikes are causing for dual eligibles; and
  • proposes ways to restrict them in the Medicare market.

Denny Chan, Public Interest Lawyer

By | DUAL ELIGIBLES, Health Equity, IN THE NEWS, Medicaid, Newsroom

ETTV America: Denny Chan, Public Interest Lawyer (May 29, 2019)

Even when faced with questionable or improper behavior, many AAPI older adults may decide not to speak up.  In a mini-series highlighting individuals for Asian American Pacific Islander Heritage Month, ETTV – a Chinese-language television station – interviewed Justice in Aging Senior Staff Attorney Denny Chan.  In addition to sharing his personal story of why he advocates for low-income seniors, Denny discusses reasons why AAPI older adults might stay quiet, even if they are improperly billed for medical services, and encourages them to be involved in their healthcare.  “Many older adults in our community feel an immense sense of gratitude after immigrating from their home countries.  Their benefits may be better here than where they came from.  Of course, this is something to appreciate, but older adults should speak up if they are mistreated by the government.” This interview is in Chinese.

Health Care for Elders with Limited English (in Chinese)

By | DUAL ELIGIBLES, Health Equity, IN THE NEWS, Medicaid, Newsroom

AARP TV: Health Care for Elders with Limited English (May 1, 2019)

There are currently about five million older adults with limited English proficiency in the United States, and the numbers are growing. It is important that LEP older adults know their rights in health care settings, and feel comfortable speaking up and asking for materials to be translated into their language or for translation services, if needed. This interview with Justice in Aging Senior Staff Attorney, Denny Chan talks to AARP about how LEP seniors can learn about and exercise their rights. This interview is subtitled in Chinese.

Health Care for Elders with Limited English (in English)

By | DUAL ELIGIBLES, IN THE NEWS, Medicaid, Newsroom

AARP TV: Health Care for Elders with Limited English (May 1, 2019)

There are currently about five million older adults with limited English proficiency in the United States, and the numbers are growing. It is important that LEP older adults know their rights in health care settings, and feel comfortable speaking up and asking for materials to be translated into their language or for translation services, if needed. This interview with Justice in Aging Senior Staff Attorney, Denny Chan talks to AARP about how LEP seniors can learn about and exercise their rights. This interview is in English.

 

Fact Sheet: CMS Regulations Set Ground Rules for D-SNP

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

The Centers for Medicare and Medicaid Services (CMS) recently finalized rules implementing regulations governing minimum integration standards for Dual Eligible Special Needs Plans (D-SNPs) pursuant to the Bipartisan Budget Act of 2018. D-SNPs are Medicare Advantage plans that limit enrollment to individuals who are dually eligible for Medicare and Medicaid. With the permanent authorization of D-SNPs, we expect to see an increase of D-SNPs entering the market across the country.

Justice in Aging has analyzed the new regulations and created a new factsheet summarizing the major integration requirements including special considerations for advocates.

Fact Sheet: Health Care Provisions in the Bipartisan Budget Act of 2018

By | DUAL ELIGIBLES, FACT SHEET, Medicare

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.

Read the Fact Sheet

Advocates Guide To California’s Coordinated Care Initiative Version 6

By | Advocate's Guide, CA Health Network Alert, DUAL DEMONSTRATIONS, DUAL ELIGIBLES

The Coordinated Care Initiative (CCI)—including California’s dual eligible demonstration project Cal MediConnect—is well underway in all seven CCI counties including Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. There have been significant changes to the CCI since the release of Version Five of Justice in Aging’s Advocates Guide to California’s Coordinated Care Initiative in October 2016.

Released today, Version Six of the Guide includes:

  • A description of new and updated CCI policies
  • Additional advocacy tips
  • Evaluation results and new resources

If you have saved or printed Version Five, please replace it with Version Six, because the former now contains outdated information.

If you missed the webinar, Coordinated Care Initiative: 2017 Update, the video is now available.

WEBINAR: Updates on Managed Care for Dual Eligibles and Medicare Coordination Programs

By | DUAL ELIGIBLES, Health Care, Medicaid, Medicare, WEBINAR
When: Wednesday, September 20th at 11:00 a.m. PT/2:00 p.m. ET.

Dual eligible individuals, those with both Medicare and Medicaid coverage, represent the most medically needy and costly population for both Medicare and Medicaid. In an effort improve health outcomes and reduce healthcare spending, the Centers for Medicare and Medicaid Services (CMS) has been testing  financial alignment demonstrations in thirteen states to better coordinate and integrate care for dual eligibles. Read More

Repeal of the ACA—Without a Replacement—Threatens California Seniors

By | Affordable Care Act, BLOG, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care, Health Care Defense, HOMEPAGE, Medicaid, Medicare
There are currently 7.6 million older adults living in California who rely on Medicare, Medi-Cal, and the Affordable Care Act (ACA) to see a doctor, receive care in their home, and pay for prescription drugs. The repeal of the ACA threatens these critical programs, jeopardizing the care seniors receive every day. Read More

Repealing the Affordable Care Act without a Replacement Hurts Seniors

By | Affordable Care Act, BLOG, DUAL ELIGIBLES, Health Care, Health Care Defense, HOMEPAGE, Medicaid, Medicare, Safety Net Defense
Every day, whether seniors need to see a doctor, receive care in their home, or pay for prescription drugs, Medicare, Medicaid, and the Affordable Care Act (ACA) are lifelines for older adults. However, the entire health care system upon which older adults rely is at risk in the new Congress. Changes to the ACA will dramatically alter the Medicare and Medicaid programs, and jeopardize the care seniors receive each day. Read More