Category

Medicaid

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. 

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Dozens of Senior Care Homes That Broke Labor Laws Continue to Get Medicaid Funds

By | IN THE NEWS, Medicaid, Nursing Homes

Reveal from The Center for Investigative Reporting: Dozens of Senior Care Homes That Broke Labor Laws Continue to Get Medicaid Funds (December 14, 2019)

This story is the fourth in an investigative series about wage theft and worker exploitation in Medicaid-funded board and care homes in California, Florida, Oregon, and Wisconsin. Companies may be prohibited from collecting Medicaid if they have been convicted of Medicare or Medicaid fraud or patient abuse or neglect, among other offenses. However, the federal agency that administers Medicaid – the Centers for Medicare & Medicaid Services – does not police whether senior care-home operators comply with wage and hour laws. “Medicaid certification is a privilege, not a right, and payment should depend upon complying with relevant laws,” said Eric Carlson, a directing attorney at Justice in Aging. “Underpaying employees is a red flag for health care quality.” This story also appeared in The New York Times, Washington Post, Minneapolis Star Tribune, Seattle Times, US news and World Report, and the San Diego Union Tribune.

California’s Master Plan For Aging: Make Medi-Cal More Affordable

By | FACT SHEET, Long Term Care, Medicaid, Toolkit

California has committed to developing a Master Plan for Aging in order to meet the needs of older adults today and for generations to come. Justice in Aging will release a series of short papers containing specific policy recommendations, developed with partners, that the Master Plan for Aging must include to meet its goals to advance equity, increase economic security and safety, and improve access to quality, affordable health care and LTSS programs.

The first in this series of papers, Make Medi-Cal More Accessible and Affordable, offers eight specific policy recommendations for improving Medi-Cal in order to ensure that every low-income older adult in California is able to access high quality, affordable health care. This paper was developed with developed with partners at Disability Rights California and Western Center on Law & Poverty.

 

Many Enrolled in California Healthcare Plan Lack Interpretation Services, Surveys Show

By | DUAL DEMONSTRATIONS, DUAL ELIGIBLES, IN THE NEWS, Language Access, Medicaid, Medicare

The Sacramento Bee: Many Enrolled in California Healthcare Plan Lack Interpretation Services, Surveys Show (November 6, 2019)

Half of the non-English speaking people enrolled in Cal MediConnect reported they could never get a medical interpreter when they needed one, according to a survey conducted by San Francisco State University. Currently, Cal MediConnect is a pilot program that coordinates care for dual eligibles in seven California counties. However, a similar program will be rolled out that requires all of California’s dual eligibles to receive care through managed care plans. This new program is called CalAim. “Our experience in Cal MediConnect can be used to predict where potential language access barriers might be in this new model ‘CalAim’,” said Denny Chan, senior staff attorney at Justice in Aging. “Sooner or later, this will affect all duals across California. The agencies want to move people to managed care plans across the state, so it is important for us to make sure these problems don’t continue.”

Issue Brief & Fact Sheet: What’s at Stake for Older Adults When States Eliminate Retroactive Medicaid Coverage?

By | Affordable Care Act, FACT SHEET, Health Care, ISSUE BRIEF, Long Term Care, Medicaid

Retroactive Medicaid coverage is a key financial protection that helps older adults and others who develop sudden illnesses or long term care needs access the care they need right away. It is a smart policy intended to protect low-income people from crushing medical debt in instances where they need emergency medical or long-term care and cannot apply for Medicaid immediately. But several states are eliminating this protection through Medicaid demonstration waivers approved by the federal government.

A new Justice in Aging issue brief—Medicaid Retroactive Coverage: What’s at Stake for Older Adults When States Eliminate This Protection?—discusses typical situations that cause older adults to need Medicaid retroactive coverage, and how the policy helps them access care, while protecting them from financial hardship. The issue brief also delves into how states are using waivers to eliminate this coverage, which states are doing so, and how older adults, their families, and health care providers are harmed when the coverage is eliminated. A companion fact sheet provides a higher level view of the issue.

 

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.

Free Webinar: The Qualified Medicare Beneficiary (QMB) Program—An Update for Advocates: Part 2 of 2

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

When: Wednesday, July 24, 2019 11 am-12 pm PT/2-3 pm ET​

The Qualified Medicare Beneficiary (QMB) program provides significant Medicare cost savings to low income individuals, including payment of Medicare premiums and protection from liability for any Medicare co-insurance or deductibles for health services. Those enrolled in the program also are automatically enrolled in the Part D Low Income Subsidy program (LIS). Despite its value, the QMB program is chronically under-enrolled. Many eligible individuals don’t know about the program or face barriers when they try to enroll. Those who are enrolled often face difficulties in accessing QMB protections.

This two-part webinar series gives advocates updated information on the QMB benefit and tools to use to ensure that their clients are enrolled and can use the benefit effectively.

Part One provides an overview of the QMB program, including eligibility criteria and program basics and focus on the specifics of QMB billing protections. We focus on recent improvements that make it easier for QMBs and their advocates to understand their payment responsibilities and the tools available to address problems with providers who improperly bill QMBs. We also distinguish between the QMB program and a Medicaid agency’s Part B buy-in agreement, and discuss QMB issues in Medicare Advantage.

Part Two focuses on enrollment. It looks at barriers to QMB enrollment, including problems that have arisen in various states and advocacy approaches, especially for individuals with Medicaid linked to Supplemental Security Income. We explore both ways to untangle individual problems and ways to work with your state to improve QMB enrollment systemically.

Who should participate:
Aging and legal advocates, community-based providers and others who counsel older adults on health benefits.

Presenters:
Denny Chan, Senior Staff Attorney, Justice in Aging
Georgia Burke, Directing Attorney, Justice in Aging

Part 1 occurs on Tuesday, July 23, 2019 11 am-12 pm PT/2-3 pm ET​

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Free Webinar: The Qualified Medicare Beneficiary (QMB) Program—An Update for Advocates: Part 1 of 2

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

When: Tuesday, July 23, 2019 11 am-12 pm PT/2-3 pm ET

The Qualified Medicare Beneficiary (QMB) program provides significant Medicare cost savings to low income individuals, including payment of Medicare premiums and protection from liability for any Medicare co-insurance or deductibles for health services. Those enrolled in the program also are automatically enrolled in the Part D Low Income Subsidy program (LIS). Despite its value, the QMB program is chronically under-enrolled. Many eligible individuals don’t know about the program or face barriers when they try to enroll. Those who are enrolled often face difficulties in accessing QMB protections.

This two-part webinar series gives advocates updated information on the QMB benefit and tools to use to ensure that their clients are enrolled and can use the benefit effectively.

Part One provides an overview of the QMB program, including eligibility criteria and program basics and focus on the specifics of QMB billing protections. We focus on recent improvements that make it easier for QMBs and their advocates to understand their payment responsibilities and the tools available to address problems with providers who improperly bill QMBs. We also distinguish between the QMB program and a Medicaid agency’s Part B buy-in agreement, and discuss QMB issues in Medicare Advantage.

Part Two will focus on enrollment. It will look at barriers to QMB enrollment, including problems that have arisen in various states and advocacy approaches, especially for individuals with Medicaid linked to Supplemental Security Income. We will explore both ways to untangle individual problems and ways to work with your state to improve QMB enrollment systemically.

Who should participate:
Aging and legal advocates, community-based providers and others who counsel older adults on health benefits.

Presenters:
Denny Chan, Senior Staff Attorney, Justice in Aging
Georgia Burke, Directing Attorney, Justice in Aging

WATCH THE WEBINAR
DOWNLOAD THE POWERPOINT