Category

Health Care

Justice in Aging Joins Amicus Brief Urging the Supreme Court to Defend the ACA

By | Health Care, Medicaid, Medicare, PRESS RELEASE

On January 15, Justice in Aging joined AARP and the Center for Medicare Advocacy in submitting an amicus brief urging the U.S. Supreme Court to expedite its review of a case challenging the constitutionality of the Affordable Care Act (ACA). The brief argues that the uncertainty caused by the Fifth Circuit’s decision to remand the case to the district court is harming older adults and that declaring the entire ACA unconstitutional will cause millions of older adults to lose health insurance coverage and vital consumer protections.

Several states led by Texas, along with the U.S. Department of Justice, are asking the courts to declare the entire ACA unconstitutional because Congress zeroed out the tax penalty for not complying with the law’s individual mandate to have health insurance. A federal district judge agreed and issued a ruling that the entire ACA is unconstitutional in December 2018. On appeal, the Fifth Circuit decided that the individual mandate without a penalty is unconstitutional, but remanded the decision back to the district court to review the ACA provision-by-provision to determine whether each is viable without the mandate.

Our amicus brief, filed in support of the states and the U.S. House of Representatives who are defending the ACA, demonstrates how the ACA’s critical protections and coverage expansions have improved the health and well-being of older adults, and how invalidating the ACA would disrupt the entire health care system, undermine the Medicare and Medicaid programs, and harm low-income seniors and their families. As explained in our statement on the Fifth Circuit’s decision and in our issue brief on the importance of the ACA to low-income older adults, millions of older adults and people with disabilities are alive and healthier today because the ACA enabled access to health care they couldn’t otherwise obtain.

Because of the ACA:

  • The lives of over 19,200 older adults on expanded Medicaid have been saved.
  • Seniors and people with disabilities have more opportunities to age in place and live at home, in their communities, where they want to be.
  • There is more care coordination for individuals who are dually eligible for Medicare and Medicaid and better protections for the lowest-income seniors from illegal billing for Medicare cost-sharing.
  • Seniors have stronger protections from discrimination and a new avenue for enforcing their civil rights.
  • Medicare beneficiaries have better access to preventive services and prescription drug coverage.

If the Supreme Court is persuaded by our arguments and upholds the constitutionality of the ACA, 100 million Americans with pre-existing conditions and 13 million Americans enrolled in expanded Medicaid will be able to move on with their lives without fear of losing coverage. And we can continue to build on the progress we have made using the ACA’s tools to enhance care coordination and consumer protections for Medicare and Medicaid beneficiaries, end discrimination, and eliminate health disparities, and achieve Justice in Aging for all.

Fact Sheet: Coverage Changes for Opioid Treatment Services for Dually Eligible Individuals

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

As of January 1, 2020, Medicare Part B covers a new Opioid Treatment Program (OTP) benefit. This means Medicare beneficiaries now have access to methadone for medication-assisted treatment (MAT) in an out-patient setting, along with counseling and other opioid use disorder (OUD) treatment services delivered by a certified OTP provider.

For individuals dually eligible for Medicare and Medicaid, this new coverage means that Medicare is now the primary payer for these OUD treatment services. The Centers for Medicare & Medicaid Services (CMS) has issued guidance to OTP providers, MA plans and to states to help ensure that dually eligible individuals who are currently receiving these OUD treatment services do not experience interruptions in care.

Justice in Aging’s new fact sheet describes the new OTP benefit and how it affects dually eligible individuals access to treatment for OUD. Advocates working with dually eligible individuals or other Medicare beneficiaries receiving or in need of OUD treatment services should become familiar with these changes to help clients navigate and identify any issues.

For example:

  • OTP providers and MA plans are prohibited from billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost-sharing for OTP services. In addition, all people enrolled in Original Medicare should not pay any cost-sharing for OTP services once they have met their Part B deductible.
  • States, MA plans, and providers should be following guidance to ensure continuity of care for dually eligible beneficiaries who are currently receiving OTP services.
  • State Medicaid programs cannot exclude or deny coverage of transportation (NEMT) for dually eligible individuals to Medicare-covered benefits, including OTP services.

Please let us know if you observe any issues with these changes in Medicare coverage of OUD treatment services. Your feedback helps us identify systemic issues and work with CMS to resolve them.

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

Medicare Doesn’t Cover Dental Care. For Many Florida Seniors, That’s a Problem

By | Health Equity, IN THE NEWS, Medicare, Oral Health, Uncategorized

Miami Herald: Medicare Doesn’t Cover Dental Care. For Many Florida Seniors, That’s a Problem (December 20, 2019)

Spotty coverage — combined with high oral health costs — means many older adults like Domínguez and Morejón, the two people discussed in this story, have no path to getting dental care. According to Justice in Aging, a national non-profit legal advocacy organization, only half of all 60 million Medicare beneficiaries saw a dental provider in the past year. “When we speak with older adults, lack of access to dental care is very much top of mind for them,” said Jennifer Goldberg, Justice in Aging’s Deputy Director. “And that lack of access to dental coverage has a disparate impact on populations of color.”

Issue Brief: Qualified Medicare Beneficiary (QMB) Protections in Medicare Advantage: Issues, Tips and Avenues for Advocacy

By | Health Care, ISSUE BRIEF, Medicare, REPORTS

The Qualified Medicare Beneficiary (QMB) program is a Medicaid benefit that pays for Medicare premiums as well as protects individuals from coinsurance and copayment for Medicare-covered services. QMB protections apply whether a beneficiary receives Medicare through Original fee-for-service Medicare or a Medicare Advantage plan.

A new Justice in Aging issue brief, Qualified Medicare Beneficiary (QMB) Protections in Medicare Advantage: Issues, Tips, and Avenues for Advocacy, looks at how QMB protections apply to beneficiaries enrolled in Medicare Advantage plans and discusses ways advocates can address common issues that arise for QMB beneficiaries in Medicare Advantage. It also identifies areas for advocacy to make Medicare Advantage work more smoothly for QMBs.

In AEP Home Stretch, CMS Grapples with Plan Finder “Glitches”

By | Health Care, IN THE NEWS, Medicare

AIS Health: In AEP Home Stretch, CMS Grapples with Plan Finder “Glitches” (December 5, 2019) RADAR on Medicare Advantage

Despite a major overhaul to the Medicare Plan Finder (MPF) that was readied in time for the Annual Election Period ending on Dec. 7, multiple reports at press time indicated that the online tool was providing inaccurate cost estimates for users, especially relating to prescription drugs. In a blog post responding to the reports, CMS said it stands by the accuracy of the tool, but it acknowledged that it has been making updates to the MPF as issues are flagged, giving weight to consumer advocates’ concerns that CMS did not allow enough time for testing the tool before rolling it out.

“At the outset, CMS did not provide enough time to test the functionality of the tool, which has led to ‘testing in real time’ with real ramifications to Medicare beneficiaries and their ability to access care,” said Directing Attorney, Amber Christ. This article is behind a paywall, but the publisher, allowed us to reprint it. Click below to read the full story.

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FAQ: Adding a Dental Benefit to Medicare Part B

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

As Justice in Aging has been engaged in advocacy to add an oral health benefit to Medicare Part B, we’ve received a number of questions from advocates and others about how older adults currently access oral health benefits, what coverage the various parts of Medicare offer, and what adding an oral health benefit to Medicare Part B would look like.

We created a new resource, Adding a Dental Benefit to Medicare Part B: Frequently Asked Questions, to answer these common questions.

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.

Fact Sheet: Open Enrollment for 2020 Coverage through Medicare & the Marketplace—Basics for Advocates

By | Affordable Care Act, FACT SHEET, Health Care, Medicare, REPORTS

Justice in Aging has updated our national 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.

Issue Brief: Adding a Dental Benefit to Medicare – Addressing Racial Disparities

By | Health Care, ISSUE BRIEF, Medicare, Oral Health, REPORTS

The Medicare statute currently excludes nearly all dental coverage for the 60 million older adults and people with disabilities who rely on the program. This dental exclusion disproportionately impacts populations of color, who suffer adverse oral health outcomes at significantly higher rates than white older adults.

Justice in Aging’s new issue brief, Adding a Dental Benefit to Medicare: Addressing Racial Disparities, examines how adding an oral health benefit to Medicare would address disparities in access to care and oral health outcomes based on race, and puts forth additional policy options that can be implemented to further advance oral health equity.

This issue brief is the first in a series of papers that will examine how to address disparities in access to care and oral health outcomes among certain groups of Medicare beneficiaries, including people of color, people with disabilities, older adults with dementia and cognitive impairments, and nursing facility residents.