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ISSUE BRIEF

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.

 

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.

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.

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

Issue Brief: Medicaid Work Requirements and Family Caregivers

By | Health Care, Health Care Defense, ISSUE BRIEF, Medicaid, REPORTS, Safety Net Defense, SENIOR POVERTY

Medicaid Work Requirements can cause family caregivers to lose their health coverage, putting their health and the health of the older adults they care for in jeopardy.

With Thanksgiving on the horizon, our thoughts are on families and the 40 million family caregivers who provide care to an adult family member. Medicaid is an important source of health insurance coverage for those family caregivers who do not have access to other affordable coverage options. However, many states are in the process of designing or implementing policies that require family caregivers and others who are eligible for Medicaid to work a certain number of hours per month or qualify for an exemption to maintain their health coverage.

Implications for family caregivers

Low-income family caregivers may be unable to work sufficient hours at a paid job because of their caregiving responsibilities and may not qualify for the state’s exemptions. As a result, many will lose access to health care they need to maintain their own health, harming both their own well-being and the well-being of the older adults they care for.

A new Justice in Aging issue brief provides a state-by-state survey of how Medicaid work requirements apply to family caregivers and explains the harms they will cause to family caregivers and the older adults they care for.

READ THE BRIEF

Issue Brief: Medicaid Enrollees Put at Risk When State Medicaid Programs Assume Support from Family Caregivers

By | Health Care, Health Care Defense, ISSUE BRIEF, Medicaid

A new Issue Brief reveals how states’ assumptions often deprive Medicaid recipients of needed assistance.

Under Medicaid law, all assistance by friends and family members must be voluntary. This brief, based on a review of over 100 administrative decisions in several states, shows how Medicaid programs violate this law to the detriment of people on Medicaid. Medicaid programs often deny services based on family assistance that is not available. This puts lives at risk, increases the chances that a beneficiary will have to be institutionalized, and forces families to make impossible choices between caring for a family member and going to work.

The issue brief outlines states’ responsibility to respect the voluntary nature of assistance, examines how some states approach the issue, and suggests public policy responses to ensure that states authorize adequate assistance.

Rachel Gershon, of the University of Massachusetts Medical School’s Center for Health Law and Economics co-authored this paper with Justice in Aging attorney, Eric Carlson. The paper is part of a post-fellowship project with Justice in Aging and the Borchard Foundation Center on Law and Aging. 

White Paper: An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care

By | Health Equity, ISSUE BRIEF, Medicare, Oral Health

Oral health is an integral part of overall health. Oral health problems can adversely affect one’s ability to maintain optimal nutrition, self-image, social interactions, and mental and physical health. Oral health problems can lead to chronic pain, tooth loss and serious infections. Poor oral health can even worsen chronic medical conditions such as heart disease and diabetes.

Older adults need timely and affordable access to dental care in order to maintain their health and well-being, yet, there is currently no mechanism for most older adults to access care. Contrary to what many believe, Medicare does not include an oral health benefit. Most older adults cannot afford to purchase private oral health insurance or pay out-of-pocket for the care they need. As a result, 70 percent of Medicare recipients have limited or no dental coverage, and fewer than half see a dentist each year.

A new White Paper, An Oral Health Benefits in Medicare Part B: It’s Time to Include Oral Health in Health Care discusses how a Medicare Part B dental benefit would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education. The paper also details how such a benefit could be structured and the legislative changes that would need to happen before such a benefit could be established.