Category

REPORTS

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. 

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.

Issue Brief: D-SNP Look-Alikes – A Primer

By | DUAL ELIGIBLES, ISSUE BRIEF, Medicaid, Medicare, REPORTS

More dual eligibles—individuals with Medicare and Medicaid—are enrolling in a certain type of Medicare Advantage plan as a result of aggressive marketing efforts targeting dual eligibles. This type of plan, known as a Dual Eligible Special Need Plan (D-SNP) Look-Alike, threatens to undermine promising advancements in integrated care for duals made possible by the Affordable Care Act (ACA). D-SNP look-alikes are not subject to the regulations governing D-SNPs and therefore have no responsibility to coordinate Medicare and Medicaid benefits. Because they are marketed aggressively almost exclusively to duals, they draw dual eligibles away from coordinated options and place responsibility on the consumer to navigate two separate delivery systems, potentially exacerbating disruptions and gaps in care.

Justice in Aging created this issue brief, Dual Eligible Special Need Plan Look-Alikes – A Primer, to help educate advocates working with dual eligibles about the impact of these plans on dual eligibles and to request that advocates report experiences with D-SNP look-alikes to Justice in Aging and CMS.

This new issue brief:

  • Outlines some key requirements of D-SNPs;
  • identifies the basic characteristics of D-SNP look-alikes;
  • discusses problems look-alikes are causing for dual eligibles; and
  • proposes ways to restrict them in the Medicare market.

Issue Brief: 10 Year Check-Up: The Affordable Care Act Has Enhanced Access to Quality Health Care for Low-Income Older Adults

By | Health Care, ISSUE BRIEF, Language Access, Medicaid, Medicare, Nursing Homes, REPORTS

As the U.S. Court of Appeals for the 5th Circuit prepares to decide the constitutionality of the Affordable Care Act (ACA) this week, it’s time for a check-up on how the law has expanded affordable coverage for low-income older adults. Our new issue brief, 10 Year Check-Up: The Affordable Care Act Has Enhanced Access to Quality Health Care for Low-Income Older Adults, discusses all the ways this landmark legislation has improved the health and economic security of older adults. The brief also discusses how the ACA has become so ingrained in the overall health system, that without the law, the system itself would collapse.

The issue brief provides a detailed look at how the ACA has expanded affordable coverage through Medicaid to more people and made it possible for more older adults to age at home and in their communities instead of in nursing facilities. Under the ACA, older adults also are protected against being charged more for pre-existing conditions and being denied essential health benefits. Low-income older adults who receive both Medicaid and Medicare get better care coordination and more help with prescription drugs. Additionally, the ACA expanded Civil Rights protections for LGBTQ and limited English proficient seniors, and stepped up oversight of nursing facilities, among other protections.

This paper shows how, after 10 years, the ACA is woven deeply into every health care program on which older adults rely. Without it, more older adults would lose their coverage, pay more for premiums and prescription drugs, be at greater risk of institutionalization, and lose many ground-breaking consumer protections. We must continue to work together to strengthen and protect this foundational program.

Advocates Guide: In-Home Supportive Services (IHSS)

By | Advocate's Guide, CA Health Network Alert, In-Home Supportive Services, REPORTS

The In-Home Supportive Services (IHSS) program is a Medi-Cal program in California that pays for in-home care for people with disabilities, including children, adults, and seniors. The purpose of this vital program is to provide services and supports that help people remain safely in their homes and living in the community.

Justice in Aging is releasing a new Advocates Guide about the IHSS program for advocates and individuals who provide assistance to older adults, children, and adults with disabilities. Written with significant support from Disability Rights California, the guide provides in-depth information about the IHSS program and is divided into eight chapters:

  • IHSS Program Overview;
  • Eligibility and Applying for IHSS;
  • Medi-Cal Programs and IHSS;
  • IHSS Services Overview;
  • Types of Services;
  • IHSS Providers;
  • Post-Eligibility Issues;
  • and Appeals and Hearings.

FAQ: Five Frequently Asked Questions About the Health Care Rights Law and Proposed Changes

By | FACT SHEET, Health Care, Health Care Defense, LGBT, REPORTS

The Trump Administration has published a proposed rule to eliminate key nondiscrimination protections under the Health Care Rights Law (Section 1557 of the Affordable Care Act) for LGBTQ seniors, people with limited English proficiency and others in health care settings. If finalized, this rule change would increase the likelihood that older adults would experience discrimination in accessing health care and make it harder for them to seek redress in the face of that discrimination.

This FAQ, “Five Frequently Asked Questions about the Health Care Rights Law and Proposed Changes,” outlines the changes including attempting to eliminate the rights of LGBTQ seniors, rolling back protections for limited English proficient (LEP) older adults, and limiting the way that victims of any type of discrimination can seek redress under the law.

Fact Sheet: Medicaid Non-Emergency Medical Transportation for Older Adults: A Critical Benefit at Risk

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

Non-Emergency Medical Transportation (NEMT) is a federally required Medicaid benefit. Within certain guidelines, each state Medicaid program is given significant discretion in crafting the NEMT benefit for Medicaid beneficiaries. This important program currently serves over 7 million Medicaid enrollees who, due to cognitive and physical changes, may have a reduced ability to drive or use public transportation. It is now under threat.

The Centers for Medicare and Medicaid Services (CMS) has signaled that it will propose a regulation in May 2019 to make the mandatory NEMT benefit optional for states. States could then choose to amend their Medicaid rules to eliminate or reduce the benefit.

A new Justice in Aging fact sheet provides advocates with information about why NEMT is important, how it is administered, and the current threat to this vital benefit, as well as information on where to go for more information and advocacy tips for preserving the NEMT benefit in their states.

Justice in Aging is working in coalition with partners like Community Catalyst to raise awareness about the importance of Medicaid transportation to ensure it remains a covered benefit.