Category

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.”

Lawsuit over observation status, SNF payment finally going to trial

By | IN THE NEWS, LITIGATION, Medicare

McKnight’s Long-Term Care News: Lawsuit over observation status, SNF payment finally going to trial (March 29, 2019)

A lawsuit, co-counseled by Justice in Aging, may go to trial which could have significant implication for providers and patients. The lawsuit involves a group of individuals having to pay out of pocket for skilled nursing facility care because Medicare would not cover it. The patients received needed care but were classified as under “observation status” and were not formerly admitted as inpatients resulting in large medical bills.

Issue Brief: Creating an Oral Health Benefit in Medicare

By | ISSUE BRIEF, Medicare, Oral Health, REPORTS

Fewer than half of older adults have access to oral health care each year. One in five older adults has untreated tooth decay and 70 percent have gum disease. Poor oral health and lack of access to health care are even more acute for low-income seniors, seniors of color, and rural seniors. Because oral health is an integral part of overall health and untreated dental problems can cause and/or exacerbate other serious health issues, it is critical to expand older adults’ access to oral health care.

Because all older adults rely on Medicare for their health care needs, integrating oral health benefits into Medicare Part B is the most effective way to deliver comprehensive benefits to all Medicare beneficiaries. Justice in Aging’s statutory analysis shows how such a benefit could be structured and where statutory language could be changed to accommodate such a benefit.

Read the Brief

Fact Sheet: Medicare Plan Enrollment Changes for Dual Eligibles and Low-Income Subsidy Recipients in California

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

The Centers for Medicare and Medicaid Services (CMS) issued new rules that limit enrollment and disenrollment from Medicare Advantage and Part D prescription drug plans for low-income Medicare beneficiaries. Previously, dual eligibles – individuals with Medicare and Medi-Cal coverage – and beneficiaries who receive the low-income subsidy (LIS) to make Part D prescription drug coverage more affordable could make enrollment changes any time throughout the year. The new rule, which became effective January 1, 2019, limits enrollment changes to once per quarter.

Justice in Aging has created a factsheet that explains these changes in detail and how they impact low-income Medicare beneficiaries in California.

Report: Older Women & Poverty

By | Economic Security, Health Care, Health Care Defense, Health Disparities, Health Equity, Long Term Care, Medicaid, Medicare, Nursing Homes, Oral Health, Safety Net Defense, SENIOR POVERTY, Social Security, Special Report, Supplemental Security Income

Because of structural inequities that impact women more than men, a significant percentage of older women are struggling to stay out of poverty.

There are 7.1 million older adults living in poverty in the United States, with nearly two out of three of them being women. Women like Venorica, who is working three jobs at the age of 70, and Vicky, who once ran a successful business with her husband, are struggling to stay afloat.

A new Justice in Aging report surveys the reasons more women are aging into poverty than men, discusses the support systems that are in place to help older women, and recommends ways we can strengthen and expand those support systems. The brief is accompanied by videos of women telling their own stories. Older women have cared for us and worked hard all of their lives. It’s imperative that we enact policies so they don’t have to struggle to make ends meet.

READ THE REPORT
WATCH THE VIDEOS HERE

Free Webinar: Improvements to the Qualified Medicare Beneficiary Program (QMB) – Part Two

By | Health Care, Medicare, WEBINAR, Webinar Trainings

Part 2: Tuesday, September 25, 2018 at 11:00 a.m. PT / 2:00 p.m. ET.

The Qualified Medicare Savings Program (QMB) helps low-income Medicare beneficiaries pay for their health insurance by covering Part A and B premiums and cost-sharing. State Medicaid programs, which administer QMB, have a responsibility to screen for eligibility, but many individuals still face challenges enrolling into the QMB program. Another challenge is that even after beneficiaries are enrolled in the program, some Medicare providers, in violation of federal law, bill QMBs for costs covered by Medicare. In the past two years, the Centers for Medicare and Medicaid Services (CMS) has implemented a number of changes to the QMB program, which touch both beneficiaries and providers, and are designed to reduce improper billing.

This two-part webinar, The Qualified Medicare Beneficiary Program: Eligibility, Challenges, and New Developments, provides an overview of the QMB program and eligibility criteria. The webinar also covers challenges to eligibility and under-utilization, and reviews the recent CMS administrative changes intended to curb improper billing.

Part Two of the two-part webinar provides:

  • An overview of the improper billing rules under the QMB program
  • A review of the recent CMS administrative changes

Who Should Participate: 

  • Aging and legal advocates, community-based providers, health plan leadership, and others wanting to learn more about the QMB program and improper billing.

Presenters:
Georgia Burke, Justice in Aging
Denny Chan, Justice in Aging

Part Two took place on Tuesday, September 25, 2018.

WATCH THE RECORDING
DOWNLOAD THE POWERPOINT

Additional Materials

Free Webinar: Improvements to the Qualified Medicare Beneficiary Program (QMB) – Part One

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

Part 1: Monday, September 24, 2018 at 11:00 a.m. PT / 2:00 p.m. ET.

The Qualified Medicare Savings Program (QMB) helps low-income Medicare beneficiaries pay for their health insurance by covering Part A and B premiums and cost-sharing. State Medicaid programs, which administer QMB, have a responsibility to screen for eligibility, but many individuals still face challenges enrolling into the QMB program. Another challenge is that even after beneficiaries are enrolled in the program, some Medicare providers, in violation of federal law, bill QMBs for costs covered by Medicare. In the past two years, the Centers for Medicare and Medicaid Services (CMS) has implemented a number of changes to the QMB program, which touch both beneficiaries and providers, and are designed to reduce improper billing.

This two-part webinar, The Qualified Medicare Beneficiary Program: Eligibility, Challenges, and New Developments, provides an overview of the QMB program and eligibility criteria. The webinar also covers challenges to eligibility and under-utilization, and reviews the recent CMS administrative changes intended to curb improper billing.

Part One of the two-part webinar:

  • Provides an overview of the QMB program, including eligibility and utilization
  • Looks at challenges to enrollment, including state enrollment procedures and data transfer issues
  • Discusses recent improvements in enrollment procedures for individuals who need QMB because they do not have premium-free Medicare Part A.

Who Should Participate: 

  • Aging and legal advocates, community-based providers, health plan leadership, and others wanting to learn more about the QMB program and improper billing.

Presenters:
Georgia Burke, Justice in Aging
Denny Chan, Justice in Aging

Part One took place on Monday, September 24, 2018.

WATCH THE RECORDING
DOWNLOAD THE POWERPOINT

Additional Materials

Fact Sheet: SSA Clarifies Handling of Medicare Part A Conditional Applications

By | FACT SHEET, Health Care, Medicare, Social Security
Many people do not have enough work history to qualify for premium-free Medicare Part A benefits, however there is still an option for low-income individuals to get their Medicare Part A premiums paid.

A new Justice in Aging fact sheet details how they can enroll in the Qualified Medicare Beneficiary (QMB) Program to get their Medicare premiums paid through their state Medicaid program. Enrolling in QMB can be confusing for people without Part A coverage and often requires visits to both the Social Security Administration office and the state’s Medicaid program offices. A further complication is that many Social Security offices have used conflicting and incorrect procedures or provided misinformation to applicants. Read More

Press Release: White Paper Stresses Importance of Oral Health Care Benefit for Older Adults

By | Health Care, Medicare, Oral Health, PRESS RELEASE

Washington, DC 2018 – Justice in Aging, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including the American Dental Association, Center for Medicare Advocacy, the Dentaquest Foundation, Families USA, Justice in Aging, Oral Health America and the Santa Fe Group.

With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, outlines the need for oral health care coverage for Medicare recipients and the importance of it being integrated with, and elevated to, the same importance as the rest of health care in Medicare. Read More