Category

FACT SHEET

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.

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.

 

FAQ: Adding a Dental Benefit to Medicare Part B

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

As Justice in Aging has been engaged in advocacy to add an oral health benefit to Medicare Part B, we’ve received a number of questions from advocates and others about how older adults currently access oral health benefits, what coverage the various parts of Medicare offer, and what adding an oral health benefit to Medicare Part B would look like.

We created a new resource, Adding a Dental Benefit to Medicare Part B: Frequently Asked Questions, to answer these common questions.

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 & 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.

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.