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Health Care

California Budget Analysis

By | Economic Security, Health Care, IN THE NEWS

Major Cuts to the Programs that Serve Older Adults Must Be Rejected

On May 14, 2020, Governor Newsom released the May Revision of the 2020-21 budget. Despite the increased need for services and supports for older adults during the COVID-19 crisis, the May Revision contains numerous and devastating cuts to the programs that older adults need and use to stay safe and healthy in their communities. Older Californians of color are at most risk of serious disease and death due to COVID-19 and these cuts will only act to widen already unacceptable disparities in access to care and health outcomes.

Below is a detailed analysis of the budget provisions impacting low-income older adults. In sum, the proposed budget would have catastrophic consequences for low-income older adults, leaving them more vulnerable to hunger, homelessness, social isolation, illness, and death during this crisis.

Home and Community-Based Services and Supports (HCBS)

The Governor’s budget proposes to eliminate and reduce three of California’s main HCBS programs that support older adults in their homes and communities so that they do not have to receive this care in nursing facility settings. These cuts are dangerous and put the health and life of older adults at real risk during this pandemic. The May Revision proposes the following:

  • Elimination of the Community-Based Adult Services (CBAS) effective no sooner than July 1, 2020. This cut will mean that 36,000 older adults and people with disabilities will lose the benefits of CBAS, which include health and social services. Many of the CBAS participants need a nursing facility level of care so elimination of the program brings an increased risk of institutionalization for participants. If federal funding is approved, this cut will not happen.
  • Elimination of the Multipurpose Senior Services Program (MSSP) no sooner than July 1, 2020. This cut will mean approximately 10,000 frail older adults 65 and over will lose access to the benefits of MSSP. Seventy-five percent of MSSP participants are over the age of seventy-five and half of participants are older adults of color and at the very highest risk of dying from COVID-19. All MSSP participants need a nursing facility level of care so elimination of the program brings an increased risk of institutionalization for participants. If federal funding is approved, this cut will not happen.
  • Reinstatement of the 7% across the board In-Home Supportive Services (IHSS) hours cut to all 625,000 recipients in the program effective January 1, 2021. Sixty-five percent of IHSS recipients are populations of color and all recipients qualify for the program based on age or disability and need for IHSS services. Reduction in hours means recipients will have to make hard choices between what care they must give up, like being bathed or getting groceries, leading to increased risk for hospitalization and institutionalization. If federal funding is approved, this cut will not happen.
  • The budget also makes additional changes and reductions to IHSS, including:
    • Conforming coverage of the IHSS-Residual program to align with Medi-Cal program eligibility. This means that individuals who lose Medi-Cal eligibility will contemporaneously lose access to IHSS. Currently, the IHSS-Residual program can provide a month or two of IHSS coverage after Medi-Cal eligibility is terminated.
    • The budget will also freeze county and public authority administration funding at 2019-20 levels to administer the IHSS program, despite growth in the program, unless federal funding is received.

Medi-Cal

The May Revision reverses gains made to expand eligibility to Medi-Cal for older adults and people with disabilities as well as cutting numerous Medi-Cal benefits. The May Revision proposes the following:

  • Elimination of the expansion of Medi-Cal income eligibility for the Aged and Disabled FPL program to 138% of the federal poverty level. This change was set to be implemented on August 1, 2020. This change would have provided free Medi-Cal to approximately 30,000 seniors and people with disabilities who will now have to remain on the Medi-Cal share of cost program.
  • Elimination of the proposed expansion of Medi-Cal to undocumented older adults 65 and over. This expansion was proposed in the Governor’s January budget and would have resulted in Medi-Cal coverage for 25,000 older immigrants who typically lack access to any other health insurance coverage.
  • Elimination of the Part B disregard, which would have stopped individuals from moving between free and share of cost Medi-Cal month-to-month because of an income counting rule. This change was set to be implemented on August 1, 2020.
  • Delaying the implementation of the CalAIM initiative, which would have made significant changes to the state’s Medi-Cal waiver. Instead of advancing the CalAIM proposal, the state will seek an extension of its current 1115 waiver from the federal Center for Medicare and Medicaid Services (CMS).
  • Reduction of adult dental benefits back to 2014 levels, which provided partial dental coverage, but did not include coverage of several vital dental services including gum treatments, root canals on back teeth, and partial dentures. These services had been restored as of January 1, 2018. If federal funding is approved, this cut will not happen.
  • Reinstatement of more expansive Medi-Cal estate recovery rules which were in place in California before January 1, 2017. This reinstatement will mean the state can seek recovery from beneficiaries’ estates for most Medi-Cal services provided. The revised rule, which has been in effect since January 1, 2017, restricts estate recovery only to the minimum required by the federal government, which include institutional long-term care and home and community-based services. If federal funding is approved, estate recovery rules will not change.
  • Elimination of optional Medi-Cal services including audiology, incontinence creams and washes, speech therapy, optician/optical lab, podiatry, acupuncture, optometry, nurse anesthetist services, occupational and physical therapy, pharmacist services, screening, brief intervention and referral to treatments for opioids and other illicit drugs in Medi-Cal, and diabetes prevention program services. If federal funding is approved, this cut will not happen.

Supplemental Security Income/State Supplementary Payment (SSI/SSP)

The budget would reduce the state supplement to the SSI grant in January 2021 by the same amount as the federal cost of living allowance. Like a number of other cuts in the budget, this cut would be triggered if the state does not receive additional federal funding. Taking income used for basic needs like housing from this vulnerable population that is already living below the poverty line would simply put more older adults and people with disabilities at risk. Instead, the state should ensure the well-being of low-income seniors and people with disabilities across the state and finally address the cuts made to the state supplement (SSP) during the recession. As part of the Californians for SSI coalition, Justice in Aging will continue advocating to increase the SSP grant to an amount that reflects the real cost of living in California.

Earned Income Tax Credit

The budget fails to make the state’s Earned Income Tax Credit more inclusive by extending the credit to immigrant workers who use an ITIN for tax filing. Extending the credit would help low-wage working families across the state make ends meet, regardless of immigration status.

Senior Programs

The May Revision also includes cuts to programs run through the Department of Aging. Some of these cuts would be offset by other appropriated dollars from the federal funding response to COVID-19, but it is not clear from the budget the extent that these cuts will be entirely offset.

  • Eliminate the augmentation for Caregiver Resource Centers (CRCs) that was approved in the 2019-20 budget, which results in losses of $20 million over two fiscal years.
  • Reduce funding for senior nutrition programs by $8.45 million with partial offset.
  • Reduce funding for the Long-Term Care Ombudsman program by $2 million.
  • Reduce funding for the Aging and Disability Resource Centers (ADRCs) by $3 million with partial offset.

We must reject these budget cuts to programs older adults rely on and most critically need during this health crisis. The state budget should protect those most at risk. This includes protecting the health and economic security programs that low-income older adults rely on and ensuring that older adults can age with justice.

Read our statement

As COVID-19 lurks, California families are locked out of nursing homes. Is it safe inside?

By | IN THE NEWS, Nursing Homes, Person-Centered Care Planning

East Bay Times: As COVID-19 lurks, California families are locked out of nursing homes. Is it safe inside? (May 10, 2020)

This article discusses the difficulties families face in knowing whether their loved ones residing in nursing homes are doing alright and receiving proper care during the COVID-19 pandemic and shelter in place orders, and offers advocacy tips for families. One of the tips is to ask for a care plan meeting. “Whenever there’s a change in someone’s condition, there’s a requirement that a care plan meeting be convened, and that remains in effect,” said Justice in Aging attorney, Eric Carlson, who was interviewed for the article.

Justice in Aging Statement on Opening Too Soon

By | Health Care, Health Disparities, PRESS RELEASE
Justice in Aging is calling on state and local governments to retain strong social distancing measures to protect the health and safety of older adults in our communities. Relaxing these measures now, even as new models are projecting a near doubling of daily deaths by June 1, is irresponsible and will cost the lives of tens of thousands of older adults. Though the curve is flattening in some places, it is spiking in others. The most critical fact is that the virus remains deadly all across America in every type of community and for every age group, but most especially for seniors, people with disabilities, and people of color. Read More

Fact Sheet: Urgent Needs of Low-Income Older Adults During COVID-19 Crisis

By | Economic Security, FACT SHEET, Health Care, REPORTS

Because older adults and people with disabilities and underlying and chronic health conditions are most at risk from both the COVID-19 virus and the range of harms caused by isolation during strict physical distancing, Congress must take urgent action to protect their lives and well-being. In particular, Congress must pay extraordinary attention to older adults who were already living in poverty and experiencing health disparities due to historical and present-day discrimination. Their intersecting health and economic disparities mean they are most at risk of dying, whether it be from COVID-19 itself or not being able to get or afford other necessary healthcare, nutrition, and housing.

Read our Policy Priorities

Free Webcast: Medicare Coverage and COVID-19

By | DUAL ELIGIBLES, Health Care, Medicaid, Medicare, WEBINAR, Webinar Trainings

The Centers for Medicare & Medicaid Services (CMS) and new legislation have changed many of the rules in Medicare to respond to COVID-19. This webcast focuses on the changes to Medicare that most impact low-income older adults.

Who should participate:
Aging and legal advocates serving older adult Medicare beneficiaries who want to learn more about navigating the changes at CMS on behalf of their clients.

Presenters:
Amber Christ, Directing Attorney, Justice in Aging
Natalie Kean, Senior Staff Attorney, Justice in Aging

This webcast took place on Tuesday, April 14, 2020, at 11:00 a.m. PT/2:00 p.m. ET.

WATCH THE WEBINAR DOWNLOAD THE POWERPOINT

Economic challenges face elderly Americans during Covid-19 shutdowns

By | Economic Security, Health Care, IN THE NEWS, Medicaid, Medicare

KFTK St. Louis, The Randy Tobler Show: Economic challenges face elderly Americans during COVID-19 shutdowns, (April 7, 2020)

Amber Christ, Directing Attorney with Justice in Aging, joined Randy to discuss the challenges elderly Americans face during the Covid-19 pandemic.

Following the passage of the CARES Act, rebates were approved to help stimulate the economy, $1200 dollars per person which most will be received automatically.  This also includes those that receive Social Security retirement or Social Security Disability. Amber discusses, this as well as some of the health care provisions in the CARES Act.

Justice in Aging Rejects Ruthless Utilitarian Policies that Devalue the Lives of Older Adults

By | Health Care, Health Disparities, PRESS RELEASE

At Justice in Aging we believe care must be provided without consideration of age or age-related criteria, including criteria that cannot be operationalized without using age as a proxy. Care must be based on individualized assessments that consider an individual’s prospects for recovery and allocate treatment to help the person survive rather than focusing allocation on “number of years of life” or “quality of life” factors. Read More

Free Webinar: Nursing Facilities and Assisted Living During COVID-19

By | Health Care, Nursing Homes, WEBINAR

When: Friday, April 3, 2020 from 11:15 a.m. PT/2:15 p.m. ET

The current outbreak of COVID-19 presents particular danger to residents of nursing facilities and other long-term care facilities. This webinar, Nursing Facilities and Assisted Living During the COVID-19 Emergency, will cover recent policy changes by federal and state governments, and discuss the challenges and choices faced by residents.

Who should participate:
Aging and legal advocates, health advocates, family caregivers, and others wanting to learn more about how policy changes related to COVID-19 impact residents of nursing homes and assisted living facilities and their families.

Presenter:
Eric Carlson, Justice in Aging

This webinar took place on Friday, April 3, 2020 from 11:15 a.m. PT/2:15 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. 

WATCH THE WEBINAR DOWNLOAD THE POWERPOINT READ THE ISSUE BRIEF

Issue Brief: The “CARES Act:” What’s in It & What’s Missing

By | Economic Security, Health Care, ISSUE BRIEF, REPORTS, Safety Net Defense, SENIOR POVERTY

On March 27th, Congress passed the CARES Act (H.R. 748), a $2 trillion funding package aimed at addressing the economic impact of the COVID-19 pandemic on Americans. Justice in Aging analyzed the bill’s provisions through the lens of low-income older adults and people with disabilities in order to update you on what’s in the bill and what’s missing. The bill makes a number of key investments that will help low-income older adults and people with disabilities.

Our high-level summary of major provisions of the CARES Act also puts forth additional policies Congress must immediately enact to meet the needs of low-income older adults in this crisis.