Innovative Partnership to Enhance Medicare Coverage for Dually Eligible Beneficiaries
Since 1987 the Center for Medicare Advocacy has partnered with the Connecticut Department of Social Services to appeal Medicare denials for care provided to dually eligible patients that was paid for by Medicaid. Pursuant to agreements with the Department, the Center pursues thousands of Medicare appeals annually for dually eligible nursing home and home health patients. We guarantee a 2 to 1 return to the State for these appeals. The Connecticut results include the following:
- Since 1987, the Center has recovered over $351 million from Medicare appeals for dually eligible Connecticut residents.
- In FY 2016-2017, the most recent complete fiscal year, the Center recovered a total of $5.6 million for Connecticut from Medicare appeals for skilled nursing facility and home health care.
In 2017 the Center successfully negotiated a settlement with CMS of pending Medicare administrative hearings that will recover approximately $17 million for appeals backlogged at the ALJ level of appeal.