Category

Health Care

FAQ: Five Frequently Asked Questions About the Health Care Rights Law and Proposed Changes

By | FACT SHEET, Health Care, Health Care Defense, LGBT, REPORTS

The Trump Administration has published a proposed rule to eliminate key nondiscrimination protections under the Health Care Rights Law (Section 1557 of the Affordable Care Act) for LGBTQ seniors, people with limited English proficiency and others in health care settings. If finalized, this rule change would increase the likelihood that older adults would experience discrimination in accessing health care and make it harder for them to seek redress in the face of that discrimination.

This FAQ, “Five Frequently Asked Questions about the Health Care Rights Law and Proposed Changes,” outlines the changes including attempting to eliminate the rights of LGBTQ seniors, rolling back protections for limited English proficient (LEP) older adults, and limiting the way that victims of any type of discrimination can seek redress under the law.

Justice in Aging’s Statement on Trump Administration’s Proposed Roll-back of Health Care Rights

By | Affordable Care Act, Health Care, LGBT, Safety Net Defense

Today as part of an ongoing attack on the most marginalized, the Trump Administration is proposing dangerous and far reaching changes to regulations implementing the Health Care Rights Law, Section 1557 of the Affordable Care Act, which prohibits discrimination in healthcare. The proposal attempts to eliminate the rights of LGBTQ people. It also rolls back protections for limited English proficient (LEP) older adults, and attempts to radically limit the way that victims of any type of discrimination can seek redress under the law. By gutting the only federal law designed to protect against discrimination in health care, the move is a cruel, extremist, and transparent political attack on LGBTQ older adults, LEP seniors, and others who frequently face discrimination in accessing care.

The ACA’s Health Care Rights provision is a landmark civil rights law that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in federal health programs and activities. The law includes affirmative protections for consumers and obligations on insurers and providers, as well as a new avenue for older adults and others to enforce their rights.

The proposed changes to the Health Care Rights Law will be particularly harmful for transgender older adults – one in five of whom report being refused care because of their gender status. This discrimination, which compounds over a lifetime, contributes to poorer health outcomes among transgender older adults, with one in three reporting poor physical health. By deleting references to protections based on gender identity, sexual orientation, and sex stereotyping across federal healthcare regulations, the Trump Administration’s proposal is saying transgender older adults and LGBTQ people more broadly do not have the right to receive the care they need and be treated with dignity.

In the same proposed rulemaking, the Trump Administration is also rolling back language access protections for LEP older adults by eliminating the requirement that healthcare providers affirmatively distribute notices of non-discrimination and include translated taglines in significant communications to consumers. These requirements, key to enforcing Title VI of the Civil Rights Act, are critical to assist LEP communities to better understand their rights and access care.

Finally, if gutting key provisions of the existing regulations were not enough, the proposed rulemaking takes aim at the Health Care Rights Law’s enforcement structure, which would make it significantly more difficult to bring particular discrimination claims under the law.

To be clear, this proposed rule is part of a larger, strategic attack on the lives of LGBTQ and LEP older adults. The Department of Health and Human Services Office for Civil Rights (OCR), the same agency tasked with enforcing Section 1557, recently released a final “Conscience Rights” rule that allows providers to discriminate against transgender older adults and others on religious and moral grounds and changed the OCR mission statement to emphasize conscience and religious freedom. Meanwhile, the Department of Homeland Security’s proposed “public charge” rule would make it nearly impossible for LEP older immigrants to enter the U.S. or become permanent residents if they are not wealthy and use or might need Medicaid or help paying for Medicare, food or housing.

Upon the proposed rule being published in the Federal Register, a 60-day public comment period will begin. In the coming weeks, Justice in Aging will provide resources, including template comments, to help advocates fight back. Now is the time to tell the Trump Administration that the lives, rights, and dignity of LGBTQ older adults, LEP seniors, and people with disabilities matter and to protect the Health Care Rights Law.

Fact Sheet: Medicaid Non-Emergency Medical Transportation for Older Adults: A Critical Benefit at Risk

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

Non-Emergency Medical Transportation (NEMT) is a federally required Medicaid benefit. Within certain guidelines, each state Medicaid program is given significant discretion in crafting the NEMT benefit for Medicaid beneficiaries. This important program currently serves over 7 million Medicaid enrollees who, due to cognitive and physical changes, may have a reduced ability to drive or use public transportation. It is now under threat.

The Centers for Medicare and Medicaid Services (CMS) has signaled that it will propose a regulation in May 2019 to make the mandatory NEMT benefit optional for states. States could then choose to amend their Medicaid rules to eliminate or reduce the benefit.

A new Justice in Aging fact sheet provides advocates with information about why NEMT is important, how it is administered, and the current threat to this vital benefit, as well as information on where to go for more information and advocacy tips for preserving the NEMT benefit in their states.

Justice in Aging is working in coalition with partners like Community Catalyst to raise awareness about the importance of Medicaid transportation to ensure it remains a covered benefit.

Dementia Patients Wait Months For Long-Term Care In Vermont Hospitals

By | Alzheimer's & Dementia, Health Care, IN THE NEWS, In-Home Supportive Services

Vermont Public Radio: Dementia Patients Wait Months For Long-Term Care In Vermont Hospitals (April 24, 2019)

Many seniors in Vermont who suffer from dementia are waiting months, and some up to a year, in hospitals before being accepted into nursing homes. Seniors affected by long wait times also tend to qualify for Medicaid and have health conditions that call for higher staffing needs. Justice in Aging’s Directing Attorney Eric Carlson said that the state’s nursing home waits are “atypical.” And that “the level of difficulty that you’re talking about in Vermont is far above what I think the average is.” Advocates recommend increasing Medicaid’s nursing home reimbursement rate and creating specialized dementia facilities.

CMS To Extend Existing Duals Demos, Invites Other States To Join

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

Inside Health Policy (April 24, 2019)

The Centers for Medicare and Medicaid Services (CMS) has invited states that aren’t currently participating in the duals demonstration to talk with the agency about starting their own version, whether through the capitated financial alignment model, the managed fee-for-service model or some other state-specific model worked out with the agency. CMS also said it plans to allow states that are already in the demonstration to make some changes, if necessary, or to extend the ongoing-demo for multiple years. Justice in Aging attorney Georgia Burke was interviewed for the article and noted that she’s happy CMS intends to work with states to continue the ongoing demonstrations and hopefully drawing on lessons learned for new states to incorporate in their demos. She also praised CMS for encouraging multiple models, and touted CMS’ emphasis on stakeholder involvement and beneficiary protections. She also noted that passive demonstration enrollment and locking in participation are not a good idea because consumer choice is important. Justice in Aging will be looking for beneficiary ombudsman programs to be included in new demonstrations. This article is unavailable online. This is a summary.

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.

More Women Growing Old Poor In Phoenix, Mirroring National Trend

By | Economic Security, Health Care, IN THE NEWS, Safety Net Defense, SENIOR POVERTY

KJZZ Public Radio: More Women Growing Old Poor In Phoenix, Mirroring National Trend (April 17, 2019)

The rate of women 55 and older experiencing homelessness is on the rise in  Phoenix, Arizona. Shelters are serving more and more older women, following national trends. Justice in Aging’s Executive Director Kevin Prindiville states that “we’re seeing a very disturbing trend of individuals that lived middle-class lifestyles when they were working age, becoming poor for the first time when they’re older — and that’s a shift.” Contributing factors include a gender wage gap, domestic abuse, a “motherhood penalty,” and caretaking responsibilities. These factors are compounded by race, sexuality, and/or gender identity. Strengthening existing social programs like improving access to SNAP and expanding 401(k) participation to part-time employees would provide the support older women need to age in dignity.

Issue Brief: Older Immigrants and Medicare

By | Health Care, Health Care Defense, ISSUE BRIEF, Language Access, Medicare

Accessing the Medicare program as an older immigrant can be a complex and confusing process – especially when an immigrant is not a citizen, has limited work history, and limited English proficiency. Justice in Aging’s new issue brief, Older Immigrants and Medicare, is intended to provide advocates who work with older immigrants a summary of the policies and practices to help immigrants enroll in and pay for Medicare coverage.

The issue brief specifically covers the following topics and includes numerous hypothetical examples to illustrate the myriad of rules and scenarios older immigrants face when attempting to access Medicare:

  • Eligibility and enrollment, with particular attention to rules affecting non-citizens
  • Help paying for coverage
  • Post-enrollment issues potentially affecting immigrant beneficiaries
  • Language access rights and resources in Medicare

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.

CMS Considering Regulation For D-SNP Look-Alike Plans

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

Inside Health Policy (April 3, 2019)

The Centers for Medicare and Medicaid Services (CMS) is considering regulating duals special needs plan look-alikes because they get in the way of state efforts to integrate Medicaid and Medicare services through Medicare-Medicaid Plans or D-SNPs and are confusing for beneficiaries. The agency asked for advocates’ feedback on the impact of the D-SNP look-alikes—which don’t have to follow D-SNP requirements—on integration, beneficiary choice, competition, state Medicaid policy and other areas.

In a call letter CMS said state commenters were unanimous in saying that D-SNP look-alikes get in the way of the comments reinforce that the proliferation of D-SNP look-alike plans impedes progress toward developing products that meaningfully integrate Medicare and Medicaid benefits for dually eligible individuals. Justice in Aging attorney Georgia Burke was interviewed for the article and said, “we are pleased CMS has identified that the look-alikes are impeding progress toward integrating Medicare and Medicaid benefits and we hope CMS moves quickly to rein in the look-alikes.”