Category

Medicare

Free Webinar: Updates on Public Charge & Older Immigrants

By | Medicaid, Medicare, Safety Net Defense, WEBINAR

When: Monday, March 9, 2020 from 11 -11:30 am PT/2-2:30 pm ET

In January, the U.S. Supreme Court removed the nationwide temporary injunction that had prevented the Department of Homeland Security (DHS) public charge immigration rule from taking effect. This means that the public charge rule that DHS finalized last August can go into effect nationwide, except in Illinois, where it is blocked by a statewide injunction. DHS announced that it will begin implementing the final rule on February 24th.

The Supreme Court’s decision endangers the health and well-being of older immigrants and their families and cruelly impedes the path to citizenship and family unification. However, it is not a final decision and we must continue to fight to stop this harmful policy from becoming permanent. The multiple cases challenging the underlying legality of the final public charge rule will continue in the courts. DHS has appealed all the district court decisions that issued preliminary injunctions to the Second, Fourth, Seventh, and Ninth Circuits. DHS has also asked the U.S. Supreme Court to hear the case.

Justice in Aging and our partners have filed amicus briefs in the Second and Ninth Circuits to ask the court to affirm the district courts’ nationwide injunctions and to highlight the ways in which this rule unfairly targets older immigrants, their families, and caregivers. This webinar, Updates on Public Charge & Older Immigrants, will begin with an overview of the public charge test and how it applies to older adults, discuss the current state of litigation, and provide information on what advocates need to know about the rule’s implementation.

Who should participate:
Aging and legal advocates, advocates serving immigrant communities, community-based providers, and others wanting to learn more about how changes to the public charge test and implementation of the new regulations impact older immigrants.

Presenter:
Denny Chan, Senior Staff Attorney, Justice in Aging
Natalie Kean, Senior Staff Attorney, Justice in Aging

This webinar took place on Monday, March 9, 2020, from 11 -11:30 am PT/2-2:30 pm 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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FAQ: Part D Drug Co-Pays and Refunds for Certain California Dual Eligibles

By | CA Health Network Alert, FACT SHEET, Health Care, Medicare, REPORTS

In 2012, the Affordable Care Act expanded the Part D Extra Help Program, also known as the Low-Income Subsidy (LIS), so that dual eligibles enrolled in certain Home and Community-Based Services (HCBS) should not be charged any co-pays for Part D covered drugs. However, since 2012, some California duals enrolled in Community-Based Adult Services (CBAS) and in San Mateo’s Multipurpose Senior Services Programs (MSSP) have been improperly charged co-pays. The Centers for Medicare & Medicaid Services (CMS) and California’s Department of Health Care Services (DHCS) is beginning to work with Part D and Medicare Advantage plans so that these dual eligibles are properly assessed co-pays and retroactively reimbursed for any improper amounts collected.

Justice in Aging created an FAQ for advocates to answer key questions about the implementation of these refunds.

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

In AEP Home Stretch, CMS Grapples With Plan Finder ‘Glitches’

By | Medicare

Reprinted with AIS Health permission from the December 5, 2019, issue of 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.

With the goal of offering a more streamlined and personalized shopping experience at Medicare.gov, the MPF this year underwent a major makeover that reportedly cost $11 million. Sources such as the Consumer Assessment of Health Plans Survey, the “Modernizing Medicare Plan Finder” report from the National Council on Aging and RAND research had raised multiple navigability issues with the tool and prompted CMS to take on the redesign. But after promising consumer advocacy groups that the new version would be available to use alongside the legacy MPF for “much of the summer,” CMS dropped the new plan finder on Aug. 27 — just seven weeks before the Oct. 15 start of the AEP.

“The Medicare Plan Finder is a critical tool for beneficiaries to make plan selections — and even more so this year in which Medicare beneficiaries on average have the choice of 28 different [stand-alone Part D] plans to enroll in,” says Amber Christ, directing attorney with Justice in Aging, referring to a recent Kaiser Family Foundation analysis.

“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,” laments Christ. Shortly after the MPF’s late August unveiling, Justice in Aging joined with the Center for Medicare Advocacy, the Medicare Rights Center and the National Council on Aging to issue a letter to CMS arguing that it did not give counselors enough time to familiarize themselves with the tool, and criticizing the decision not to allow them to fall back on the legacy MPF, which was retired at the end of September.

Meanwhile, a key feature of the tool was missing: the ability to sort Part D plans based on a beneficiary’s total out-of-pocket drug costs for the rest of the year.

CMS explained to AIS Health in September that the feature was always meant to be included in the new plan finder but couldn’t be completed in time for the late August launch. And the agency did indeed add it by the start of the AEP, when it also began enabling consumers to compare expected drug costs in stand-alone Part D plans and MA plans with prescription drug coverage and automatically load their current prescription drug list (if they are existing Medicare beneficiaries and provide their Medicare ID number).

Reports Suggest Emphasis on Premiums

But a recent Health Affairs article observed that the new MPF “explicitly emphasizes the monthly plan premium over arguably more relevant information — estimated total drug costs — which also account for expected out-of-pocket costs.” Meanwhile, total drug costs are “displayed in a small font amidst other information,” and the tool lists available plans starting with the lowest premiums, potentially steering users toward plans with low premiums when previous research has suggested this leads beneficiaries to spend more than necessary on yearly drug expenses, observed the article.

Other news reports offered detailed accounts from users around the country. When using the MPF to compare three drug plans for a client, a Medicare consultant in Wisconsin found that the summary page indicated that one of her client’s medications would not be covered — but upon clicking on “plan details” was informed that all of them would be covered, according to a Nov. 25 article from ProPublica. Further research on the plans’ websites revealed that coverage depended on which version of the same high blood pressure medication the member was taking.

In North Carolina, officials with the state’s Seniors’ Health Insurance Information Program told North Carolina Health News that costs for enrollees who receive low-income subsidies were not accurately reflected in the plan finder, and another not-for-profit agency reported that beneficiaries who entered their new Medicare ID numbers saw their forms automatically repopulate with their Social Security numbers, which were supposed to be removed from the process. And an administrator in Nebraska’s Dept. of Insurance told ProPublica that she’d flagged about 100 errors with the new tool since Oct. 1.

CMS: Information Is ‘Current,’ ‘Accurate’

“Distressed” by “the media coverage talking about ‘glitches’ or ‘malfunctions’” in the MPF, a CMS blog post dated Nov. 27 with no byline said the new tool “displays the most current and accurate information on premiums, deductibles and cost sharing that Medicare Advantage and Prescription Drug Plans provide.” That information, added CMS, “changes frequently because plans regularly update drug formularies and renegotiate drug prices,” which is “good for beneficiaries.”

CMS also reported that traffic on the plan finder website is 14% higher than last year and that the agency is already “seeing high percentages of plan switching, likely because new supplemental benefits are appealing.” However, the agency is not done improving the tool and has incorporated additional changes during the AEP as it receives feedback from users and stakeholders, including beneficiaries, caregivers and State Health Insurance Program counselors who have provided “meaningful suggestions,” added the blog post. “As we’ve said, the Plan Finder redesign is an iterative project, and in the coming months we’ll be scoping out additional improvements that we can implement based on lessons we learn this year.”

“We appreciate that CMS is working diligently to address problems that come up,” says Christ. “Our concern is that many people have already made decisions based on inaccurate plan finder information.”

Advocates Want More Flexible SEP

To ensure that beneficiaries do not experience harm, Justice in Aging has asked CMS to make the Special Enrollment Period (SEP) more flexible and to widely advertise its availability, she adds. The SEP applies when beneficiaries receive inaccurate or misleading information from the government, but it is generally narrow and requires burdensome documentation by beneficiaries, according to Justice in Aging.

That’s not to be confused with the three-month Open Enrollment Period, which starts in January and allows individuals who made an MA plan choice to switch. While that period may “help a subset of individuals who early on realize their plan selection is harmful…many won’t encounter a problem until later in the year, and they too need a way to fix a mistake that was based on erroneous or misleading plan finder information,” suggests Christ. Furthermore, the three-month open enrollment period only applies to MA, and not to PDP enrollment, she points out.

Even with MPF glitches, the AEP appears to be robust, with overall year-to-date enrollment up 7.2%, according to Credit Suisse. “The big ‘wait and see’ question will be if and when enrollees depending on Plan Finder realize they received incorrect information,” says Lindsay Resnick, executive vice president at Wunderman Thompson Health, in an email to AIS Health. “Given that the vast majority of beneficiaries complete their purchase through a licensed Medicare Advantage agent or directly with the health plan, we may not see major issues. That said, for the integrity of the MA program, the onus is on CMS to get in front of this issue with consumer facing communications about Plan Finder issues as well as clear and simple explanations of OEP rules.”

Meanwhile, private shopping platform Connecture — which prides itself on using pharmacy-specific drug pricing data (not just regional averages) collected from the largest number of carriers in the country — says it has seen significant growth in enrollments this AEP through all channels (broker, call center and direct-to-consumer) via its PlanCompare solution.

Connecture: Calculating Drug Costs Is Key

“This AEP, especially, has afforded Connecture the opportunity to educate on the importance of collecting (and saving) drug lists, knowing accurate drug costs and understanding why $0 premium plans can end up costing more if consumers don’t understand their total annual out-of-pocket estimates,” says Bill Keyes, senior vice president of sales and marketing with Connecture. “Our total cost calculators take multiple Medicare plan factors into consideration (such as the donut hole) all of which ultimately drive consumers to finding their best fit plans.”

View the Health Affairs article at https://bit.ly/2R8WK7L and the CMS blog post at https://go.cms.gov/2qYbEmJ.

Contact Christ via Vanessa Barrington vbarrington@justiceinaging.org, Keyes via Connecture Marketing Director Kara Tarantino at ktarantino@connecture.com or Resnick at lindsay.resnick@wunderman.com.

By Lauren Flynn Kelly

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.

House Passes Groundbreaking Drug Pricing Legislation that Adds a Dental Benefit to Medicare & Protects Low-Income Seniors

By | Medicare, NEWS

Yesterday, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3). This legislation takes on meaningful drug pricing reform to make momentous improvements to the Medicare program, protect low-income seniors and people with disabilities, and help older adults and families across America afford their medications.

By empowering the Secretary of Health & Human Services to negotiate drug prices on behalf of the Medicare program, H.R. 3 would make prescription drugs more affordable and generate over $450 billion in savings. The bill reinvests those substantial savings in Medicare to provide 60 million seniors and people with disabilities with dental, vision, and hearing services for the first time in the program’s nearly 55-year history. These are tangible and greatly needed benefits that will help reduce health disparities. For example, nearly 2 out of 3 people with Medicare do not currently have any dental coverage and staggering numbers have not been to a dentist in the past year: 71% of black beneficiaries, 65% of Hispanic beneficiaries, 62% of beneficiaries under age 65 with disabilities, and 59% of beneficiaries living in rural areas.

H.R. 3 would also make important progress towards better ensuring Medicare beneficiaries with limited income and resources can afford to use their coverage. It expands the Qualified Medicare Beneficiary program to individuals with incomes up to 150% of the federal poverty level and expands the Part D Low-Income Subsidy (LIS) to individuals with incomes up to 200% of the federal poverty level. These expansions would save beneficiaries thousands of dollars each year, easing their budgets and helping them keep a roof over their head and food on the table.

Read more about what H.R. 3 does to improve access to Medicare for low-income older adults and people with disabilities in our letter of endorsement.

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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