For decades, Medicare beneficiaries – particularly those with long-term or debilitating conditions and those who need rehabilitation services – have been denied necessary care based on a so-called “improvement standard.” This illegal practice means that Medicare coverage for vital care is denied to thousands of individuals on the grounds that their condition is stable, chronic, not improving, or that the necessary services are for “maintenance only”.
The Improvement Standard conflicts with the law. The people most affected by this barrier include people living with a range of conditions including multiple sclerosis, Alzheimer's disease, ALS (Lou Gehrig's disease), spinal cord injuries, diabetes, Parkinson's disease, hypertension, arthritis, heart disease, and stroke. Furthermore, this illegal standard disproportionately affects people who have low-incomes, as well as African Americans and Hispanics.
The Center for Medicare Advocacy and co-counsel from Vermont Legal Aid filed a class action lawsuit on January 18, 2011 against Kathleen Sebelius, the Secretary of Health and Human Services, aimed at terminating the application of the Medicare improvement standard (Jimmo, et al vs. Sebelius, 5:11-CV-17). On October 25, 2011, plaintiffs overcame a major hurdle in the lawsuit. In a comprehensive 35-page decision, Chief Judge Christina Reiss refused the federal government's request to throw out the suit. Read more here.
Watch – Edith Masterman: Fighting to Keep Medicare Services
More Information:
- Read more analysis from the Center on the Improvement Standard.
- Read the Center for Medicare Advocacy's press release about the lawsuit.
- Learn more about media coverage on this issue.
- Listen to the audio news conference about the lawsuit (streaming audio).
- Tell your story with us today, if you or someone you know has had problems obtaining Medicare coverage because their condition was said to be chronic, not stable, or not likely to improve.
- Self-Help packets
The case filing of the class action lawsuit received extensive coverage in the media, including articles by the Associated Press, Chicago Tribune, Detroit Free Press and The Hill. A more complete list media coverage is available as well.
