Home & Community Based Services

Free Webcast: Protecting Medicaid Home and Community-Based Services During COVID-19

By | Home & Community Based Services, Long Term Care, Medicaid, Medicare, WEBINAR, Webinar Trainings

During the COVID-19 crisis, it has become clear that the ability to receive services and care at home and in the community is critical to keeping people safe and healthy and to help stop the spread of the virus. Unfortunately, however, there are multiple barriers to adequate access to Medicaid home and community-based services (HCBS).

A lack of investment in HCBS by federal and state governments, scarcity of personal protective equipment for home care workers, and state cuts to HCBS programs to address budget shortfalls threaten existing HCBS infrastructure and put the lives of millions of seniors and people with disabilities at risk.

In this webcast, you will hear from disability, aging, and state advocates on what actions you can take to protect and maintain access to HCBS in your state. The webcast will include:

  • An overview of HCBS advocacy at the federal level;
  • A summary of available funding for community-based providers to respond to COVID-19; and
  • Discussion of advocacy tools to maintain HCBS infrastructure and to combat efforts to cut HCBS in state budgets.

Who should participate:
Aging and disability advocates who want to learn how to protect Medicaid Home and Community-Based Services.

Nicole Jorwic, Senior Director of Public Policy, The Arc
Amber Christ, Directing Attorney, Justice in Aging
State Advocates from Washington and Oklahoma

The webcast took place on Thursday, July 9, 11:00 a.m. PT/2:00 p.m. ET.


Free Webcast: Advocating Today and for the Future: Nursing Homes and Home and Community-Based Services in a COVID-19 World

By | Health Care, Home & Community Based Services, Medicaid, Nursing Homes, WEBINAR, Webinar Trainings

The COVID-19 pandemic presents difficulties and great risk for older Americans and people with disabilities who rely on hands-on assistance from others. Since early March, nursing home residents and others in congregate care settings have faced infection, injury, death, and relentless isolation. Home and community-based services (HCBS) programs have struggled to maintain services at necessary levels.

This Justice in Aging webcast, Advocating Today and for the Future: Nursing Homes and Home and Community-Based Services in a COVID-19 World, will look at both the present and the future. The session will bring attendees up to date on COVID-related policy changes for nursing homes and HCBS, including federal guidance for “reopening” nursing homes.

Also, the session will consider policy changes that the current crisis makes imperative. Shared-occupancy congregate care is a recipe for disaster in a COVID-19 world. The session will consider the immediate need for real change: both in remaking the nursing home model, and, more importantly, in making Medicaid HCBS available to all financially-eligible persons who need it.

Who should participate:
Aging and disability community advocates who want to learn more about advocating around nursing facility issues during COVID-19, and policy ideas for improving facilities and the long-term care system into the future.

Eric Carlson, Justice in Aging
Gelila Selassie, Justice in Aging

The webcast took place on Tuesday, June 30, 11:00 a.m. PT/2:00 p.m. ET.


Fact Sheet: How the ACA is Helping Older Adults During COVID-19

By | Affordable Care Act, FACT SHEET, Health Care, Home & Community Based Services, REPORTS

COVID-19 is putting a spotlight on our nation’s healthcare system—exposing both the ways in which programs that serve older adults are essential and the gaps. In particular, the pandemic is emphasizing how older adults’ lives are at stake in California v. Texas, when the U.S. Supreme Court decides whether to uphold the Affordable Care Act (ACA). Today, 18 states, led by Texas and the Trump Administration, submitted briefs asking the Supreme Court to strike down the ACA as unconstitutional.

Justice in Aging’s new fact sheet outlines the ways the ACA is acting as a lifeline for older adults during this pandemic. It ensures that more older adults have health insurance coverage, expands access to home and community-based services (HCBS), and prevents discrimination based on age and disability.

Eliminating the ACA’s Medicaid expansion and anti-discrimination protections would exacerbate the devastating effects of systemic racism that are causing older adults of color who to contract and die from COVID-19 at disproportionate rates.

For more on what’s at risk for low-income older adults if the ACA is struck down read our amicus brief and our 10-Year Checkup Issue Brief.

Fact Sheet: Budget Cuts to Programs for Low-Income Older Adults Must be Rejected – Cuts Would Disproportionately Hurt Older Adults of Color

By | CA Health Network Alert, Economic Security, FACT SHEET, Health Care, Home & Community Based Services, REPORTS

Governor Newsom’s revised budget makes deep cuts to nearly every program on which low-income older adults rely. The cuts to programs will be especially hard on older adults of color, who, because of systemic racism and discrimination, are at greater risk from COVID-19 and rely on these programs to survive. If enacted, these cuts will cause great harm to the health and economic security of the state’s low-income older adults and their families.

Last week, the state Senate rejected many of the cuts that the Governor proposed. Advocates need to continue to push back and educate legislators about the devastating impact of these cuts. A new Justice in Aging fact sheet discusses in more detail the specific harms of these cuts and their disproportionate impact on communities of color.

Some Nursing Homes Escaped COVID-19-Here’s What they Did Right

By | Health Care, Health Equity, Home & Community Based Services, IN THE NEWS, Medicaid, Medicare, Nursing Homes, Person-Centered Care Planning

Wired: Some Nursing Homes Escaped COVID-19-Here’s What they Did Right (May 29, 2020)

Cmiel’s staff stocked up on personal protective equipment and masks for workers and residents; screened everyone who walked in the door for symptoms; hired more staff to clean bathrooms and common areas; and started educating everyone on best practices for containing the virus. And while nursing homes account for nearly half of California’s coronavirus fatalities, at the SFCJL not a single resident has tested positive for the virus. Not all facilities were so lucky. A better approach to keep older people safe from Covid-19 would be to care for them in their homes, keeping them out of long-term residential settings. “There should be a continuum of care, and institutional care should really be reserved for people who need it, who can’t be successful and safe in their own homes,” said Claire Ramsey, Senior Staff Attorney at Justice in Aging.

Rethinking How America Cares for its Elderly

By | Health Disparities, Health Equity, Home & Community Based Services, IN THE NEWS, Medicaid, Medicare

Street Roots: Rethinking How America Cares for its Elderly (May 26, 2020)

Before COVID-19 sent the United States hurdling toward a devastating economic recession, 37 million adults aged 50 and older were already living in poverty — with another 10 million on the brink. Like it has with so many other social issues in the U.S., the coronavirus pandemic has illuminated the economic hardship and isolation facing many of our nation’s senior citizens, and the lack of value placed on the people who care for them. Executive Director Kevin Prindiville was interviewed for this article. “We’ve underinvested in our Medicaid programs and long-term care programs that help people stay home and in their community, which leaves many families with the only option to move an older family member into an institution,” Prindiville said.

Life at the Intersection: Older Adults Need a Response to COVID-19 Grounded in Equity

By | BLOG, Health Equity, Home & Community Based Services

Dorothy is in good spirits, but tired and growing increasingly impatient. In January – well before life for most Americans had been dramatically disrupted by COVID-19 with stay at home orders and the shut down of non-essential businesses – the 72-year-old Chinese American living in Seattle, Washington’s Chinatown began to see signs that her community’s life was slowing down. She’d been reading the daily headlines in the Chinese newspaper about the virus in Wuhan and other parts of China. But when the dim sum parlor across the street was only about a quarter full on a normally busy Saturday afternoon, and her building’s annual Lunar New Year celebration was cancelled, it all became real.

Dorothy’s story, and the stories of her community, highlight the importance of intersectionality in our response to the coronavirus. An intersectional framework considers the ways that various forms of inequity operate together, exacerbate each other, and sometimes create unique challenges. It can lead to better policies that recognize the different ways the older adults in our communities are experiencing the crisis.

During the period described above, Dorothy was heart-broken to learn that her neighbor, Mr. Zhang, had been attacked while riding a local bus. Mr. Zhang was riding the bus home after doing some errands, while wearing a face mask, not because he was sick but because he was aware of the asymptomatic nature of the virus; he wanted to protect himself and others. Several passengers on the bus began harassing him and threatening him. They told him to go back where he came from and threw garbage at him. Others in the Asian American Pacific Islander (AAPI) community have reported a surge in verbal and physical assaults in the wake of what President Trump has repeatedly labelled the “Chinese virus.”

Considering all the circumstances, Dorothy – like many of her neighbors – decided to self-quarantine beginning in early February. She stopped going to the nearby temple, and her local bakery in Chinatown has suspended business operations through the end of April. In the wake of the pandemic, AAPI seniors are experiencing unprecedented levels of loneliness and isolation. But the implications for older adults like Dorothy extend far beyond social – even the home and community-based services (HCBS) that keep her healthy and living in the community are affected. She has asked her caregiver to stop coming and avoids her local adult day health center.

Adding to her fears, getting local and accurate information about the pandemic has been difficult. Aside from her Chinese newspaper, information about the coronavirus in Dorothy’s native language has been limited, particularly local news with Washington-based resources and guidance. Many AAPI older adults across the country are language-isolated, which further debilitates their ability to fight the virus. Like many older adults, Dorothy is not on social media and does not regularly use mobile technology, so information is even more limited.

Supporting older adults who may be isolated, experiencing discrimination (or even hate crimes), who may be limited English proficient (LEP), in addition to being low-income, and whose cultural background is not reflected in the mainstream requires a comprehensive and intersectional COVID-19 response strategy. For Dorothy and other older adults in her community, such a strategy begins with acknowledging that her experiences and needs during the pandemic may look different from other older adults or other AAPI individuals, and is informed by her life at the intersection of multiple identities.

At a minimum, an intersectional response should:

  • Denounce Racism. Importantly, intersectionality-informed policies identify the racism and xenophobia spurred by the coronavirus and require local, state, and federal leaders to denounce it and couple their statements with providing ample support to hate crime prevention resources. For a community that lives with the trauma from the experiences of Vincent Chin, Joseph Illeto, Navrose Mody, and others, efforts to curb hate crimes and xenophobia are crucial. In response to a problematic rise of hate crimes in the wake of the virus, the New York Attorney General created a hotline to report coronavirus hate crimes and xenophobia.
  • Acknowledge Heightened Needs. COVID-19 policies must recognize Dorothy and others like her may have already started self-quarantining well in advance of any state or federal directive, and that accordingly, their needs for socialization, food security, and home and community-based services are perhaps heightened relative to those who began staying at home much later.
  • Be Culturally Competent. Policies have to be created with all communities in mind. For example, even calls from our nation’s health experts to not buy and wear masks fails to recognize the ways in which such a message may be received in AAPI communities, informed by their experiences with Severe Respiratory Syndrome (SARS) less than 20 years ago. Another example of cultural competency is around food. During this outbreak, while the need for home-delivered meals to older adults has skyrocketed, it is just as important that those meals are prepared using culturally familiar ingredients and cooking methods.
  • Include Outreach Strategies for Various Language and Cultures. At a minimum, intersectionality requires in-language resources to reach LEP older adults like Dorothy. In 2020, government agencies cannot rely solely on Google translate, tweets via social media, or employ a one-size-fits-all approach. Outreach to AAPI older adults and other communities must include partnerships with local community-based organizations and ethnic media who have the expertise to communicate with these populations.

For those older immigrants, language-isolated older adults or older adults of color, the harms of the coronavirus will undoubtedly be compounded. Dorothy, Mr. Zhang, and so many others like them are not adequately served by policies that only partially address their lived experiences. If they are going to survive this pandemic and in order for them and their communities to thrive, our response to the coronavirus must be intersectional.

*Dorothy and Mr. Zhang are not real people but their stories are based on real accounts from on-the-ground advocates, the media, and loved ones.

Summary: How States are Modifying HCBS Programs to Address COVID-19 Emergency

By | Health Care, Home & Community Based Services, Medicaid, Medicare, REPORTS

The Centers for Medicare & Medicaid Services (CMS) has begun reviewing and approving states’ emergency requests to modify their home and community-based services (HCBS) waivers. These approvals, documented through CMS’ Appendix K form, list the many modifications that CMS has approved in the past week.

As an aid to advocates, providers, and policy-makers, Justice in Aging is reviewing and summarizing the CMS approvals pertaining to aging-focused HCBS waivers. This summarized information, organized by the same categories used in Appendix K, can be a guide for advocates and others to identify useful modifications and flag others that may be problematic or otherwise unwanted.

FAQ: Low-Income Subsidy (“Extra Help”) for Dual Eligibles Receiving Home and Community-Based Services

By | FACT SHEET, Health Care, Health Care Defense, Home & Community Based Services, Medicaid, Medicare, REPORTS

The Affordable Care Act (ACA) enables full-benefit dual eligibles who receive certain Medicaid home and community-based services (HCBS) to receive Medicare Part D covered drugs at no cost. This requirement is called institutional cost-sharing, and was designed to put people who receive HCBS at home on an equal footing with those who are in institutions (who are also not charged any co-pays). Unfortunately, despite the institutional cost-sharing requirement, pharmacies still ask dual eligibles to pay co-pays for covered drugs.

Justice in Aging created an FAQ, Low-Income Subsidy (“Extra Help”) for Dual Eligibles Receiving Home and Community-Based Services, to give advocates working with dual eligibles the tools they need to prevent these co-pays. The FAQ discusses whom the cost-sharing rule applies to, the length of the cost-sharing protection, and what to do if a dual eligible HCBS-enrolled individual is prompted for a co-pay at the pharmacy or is entitled to a refund. Advocates should review the FAQ and make sure to their HCBS-enrolled dual eligibles are not paying any co-pays for their Part D drugs.

Fact Sheet: Make the Expanded Spousal Impoverishment Protection Permanent

By | FACT SHEET, Health Care, Home & Community Based Services, Medicaid, REPORTS

Married seniors and adults with disabilities overwhelming want to live at home and age in place. Increasingly, federal and state Medicaid rules have prioritized home and community-based services (HCBS) which allow people to stay in their homes and in their communities. Congress recently helped these efforts by expanding a Medicaid eligibility rule, known as the spousal impoverishment protection, to individuals eligible for HCBS. The protection makes it possible for an individual who needs a nursing home level of care to qualify for Medicaid while allowing their spouse to retain a modest amount of income and resources. However, the expansion of the spousal impoverishment protection is set to expire on March 31, 2019 unless Congress acts. This means that individuals who qualified under the expanded protection may lose access to Medicaid and to their HCBS and may be left with no choice but to move into institutional long-term care, away from their spouses.

Letting the spousal impoverishment protection expire will hurt families and force more people out of their homes and their communities. We urge Congress to make the expanded spousal impoverishment protection permanent so seniors and people with disabilities can age in place and with dignity.

Justice in Aging has created a fact sheet on the importance of the expanded HCBS spousal impoverishment protection and calling on Congress to make it permanent so seniors and people with disabilities can age in place and with dignity.