Category

REPORTS

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.

Fact Sheet: CMS Regulations Set Ground Rules for D-SNP

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

The Centers for Medicare and Medicaid Services (CMS) recently finalized rules implementing regulations governing minimum integration standards for Dual Eligible Special Needs Plans (D-SNPs) pursuant to the Bipartisan Budget Act of 2018. D-SNPs are Medicare Advantage plans that limit enrollment to individuals who are dually eligible for Medicare and Medicaid. With the permanent authorization of D-SNPs, we expect to see an increase of D-SNPs entering the market across the country.

Justice in Aging has analyzed the new regulations and created a new factsheet summarizing the major integration requirements including special considerations for advocates.

Fact Sheet: Seniors and People with Disabilities Who Receive SSI Can Apply for CalFresh in Summer 2019

By | CA Health Network Alert, Economic Security, FACT SHEET, REPORTS, Supplemental Security Income

Due in part to advocacy from groups like Californians for SSI, the 2018-2019 state budget included a policy change allowing California seniors and people with disabilities who receive SSI to be eligible for CalFresh (SNAP) benefits starting June 1, 2019.

Access to federal SNAP nutrition assistance will increase food security for California’s low-income SSI seniors and people with disabilities, leading to fewer people being forced to choose between basics like food and medicine, and giving people more flexibility to direct money toward other needs such as finding and being able to afford housing. The expansion will be particularly important for seniors age 60 or older, who represent more than half of the over 1.2 million low-income Californians who receive SSI to help meet their basic needs.

Aging services providers can learn more details about this important and historic change in a new fact sheet from Justice in Aging. The five-page fact sheet helps providers understand the details of the change in order to better support their clients. The fact sheet also includes information on CalFresh rules that will be particularly relevant for enrolling SSI seniors and people with disabilities this summer and beyond.

Issue Brief: Older Immigrants and Medicare

By | Health Care, Health Care Defense, ISSUE BRIEF, Language Access, Medicare

Accessing the Medicare program as an older immigrant can be a complex and confusing process – especially when an immigrant is not a citizen, has limited work history, and limited English proficiency. Justice in Aging’s new issue brief, Older Immigrants and Medicare, is intended to provide advocates who work with older immigrants a summary of the policies and practices to help immigrants enroll in and pay for Medicare coverage.

The issue brief specifically covers the following topics and includes numerous hypothetical examples to illustrate the myriad of rules and scenarios older immigrants face when attempting to access Medicare:

  • Eligibility and enrollment, with particular attention to rules affecting non-citizens
  • Help paying for coverage
  • Post-enrollment issues potentially affecting immigrant beneficiaries
  • Language access rights and resources in Medicare

Issue Brief: Cal MediConnect-Unmet Need and Great Opportunity in

By | Health Care, ISSUE BRIEF, Medicaid, mltss

CalMediConnect, launched in 2014, is California’s dual eligible demonstration and seeks to integrate Medicare and Medicaid benefits under one health plan. One of its purposes is to better meet the needs of dual eligibles by increasing access to long-term services and supports (LTSS) and providing other value-added services, known in the demonstration as Care Plan Options (CPO). However, evaluation data and beneficiary experience indicate that more can be done to provide care for dual eligibles enrolled in the program. Justice in Aging recently obtained data via a Public Records Act request from California’s Department of Health Care Services that includes LTSS referrals and the number and type of CPO services plans are providing members.

Our issue brief, Cal MediConnect: Unmet Need and Great Opportunity in California’s Dual Eligible Demonstration, provides a brief overview of the Cal MediConnect program and examines the health plan referral data for LTSS and CPO services obtained through the Public Records Act request. It concludes with recommendations for policymakers on ways to strengthen Cal MediConnect through improving access to LTSS and CPO services. These recommendations are of interest to those following Cal MediConnect as well as advocates and stakeholders in other states with their own dual eligible demonstrations.

Read the brief.

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.