The Administration is at it again. Last weekend, the Department of Homeland Security released the text of a proposed rule that would create hardships for certain immigrants seeking permanent residency (green cards) in the U.S. This “public charge” proposed rule would also place additional barriers in the way of immigrants seeking to enter the country. … Read more

In conjunction with other advocacy organizations, the Center for Medicare Advocacy submitted comments during the re-opened comment period for the Kentucky HEALTH Medicaid Section 1115 waiver demonstration application. The Center strongly believes that Kentucky HEALTH should be rejected as it will lead to substantial coverage losses. Kentucky’s proposal will take health coverage away from individuals … Read more

The Medicare-Medicaid Coordination Office’s Integrated Resource Center (ICRC) of the Center for Medicare & Medicaid Services recently released an issue brief addressing the challenges of access to durable medical equipment (DME) for dually eligible beneficiaries. The brief, Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches, … Read more

The Senate bill is still a secret, but what we’ve learned isn’t good.  Senate leadership is pushing for a vote by the end of next week. While some information about policy changes is leaking out, such as the Medicaid payment rates referenced below, the bill is still a secret – no text, no hearings, no … Read more

— Advocates Oppose Medicaid Block Grants and Per Capita Caps — March 3, 2017 Contact: Center for Medicare Advocacy – Matthew Shepard: 860-456-7790, Justice in Aging – Vanessa Barrington: 510-256-1200, Medicare Rights Center – Mitchell Clark: 212-204-6286, Washington, DC — Today, the Center for Medicare Advocacy, Justice in Aging, the Medicare Rights … Read more

According to a recent report from Vox, Congressional plans to repeal key provisions of the Affordable Care Act (ACA) will have devastating consequences for thousands of Americans each year. Vox’s Julia Belluz cites evidence to estimate that 24,000 Americans would die annually if Congress repeals vital provisions of the ACA without simultaneously enacting an appropriate … Read more

Continued health care coverage authorized by the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly referred to as COBRA, provides a great step forwarded in reducing gaps in insurance for people between jobs or losing coverage due to the death of the covered worker in a family.  The rules for COBRA coverage are, nonetheless, complicated.  … Read more

Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage (MA) plan that enrolls only individuals dually eligible for Medicare and Medicaid. Though results have been mixed, D-SNPs were created as a possible route to better integration between Medicare and Medicaid, in turn leading to better quality, higher value care. Authority for Special … Read more

Created in 1956, the Social Security Disability Insurance Program (SSDI)[1] provides modest but essential support to 14 million working-age individuals with disabilities and children.[2] Recently, the SSDI program has come under attack by policymakers and others critics who suggest that the program's spending is "out of control." Critics contend that unless drastic changes are made, … Read more

In the midst of ongoing budget discussions, policymakers are considering a wide array of approaches for cutting spending and saving federal dollars. The Center for Medicare Advocacy recently wrote of ways to strengthen the Medicare program while achieving significant savings.[1] Included in our analysis was a proposal that would save taxpayers billions of dollars: reinstating … Read more

Under the Affordable Care Act, states will be eligible for greatly increased federal-match payments beginning in 2014 if they expand their Medicaid programs to cover adults with incomes up to 133% of the Federal Poverty Level (FPL).  In a letter dated December 10, 2012, Secretary of Health and Human Services (HHS) Kathleen Sebelius said that … Read more

Noting that "[w]e are excited about the demonstrations and would like them to succeed," the Center for Medicare Advocacy (the Center), and thirty-two other national consumer advocacy and provider organizations have called on the Centers for Medicare & Medicaid Services (CMS) to scale back the scope, size, and timing of state-based demonstrations that would change … Read more

Introduction In its June 2012 Report to the Congress, the Medicare Payment Advisory Commission (MedPAC) included an examination of current options and activity with respect to programs that integrate – or have the potential to integrate – Medicare and Medicaid services and financing for those individuals with coverage from both programs, often referred to as … Read more

The nearly nine million Medicare beneficiaries who are also eligible for some form of Medicaid, the so-called dual eligibles, are the subject of federal, state and local policy discussions because many of them are among the highest users of health care services in the country and thus are very costly to both Medicare and Medicaid.  … Read more

The Centers for Medicare & Medicaid Services (CMS) recently announced several new initiatives focused on improving care for people who are eligible for both Medicare and Medicaid (dual eligibles). Two initiatives relate to providing fully integrated services to dual eligibles, through both capitation and fee-for-service structures.  A third initiative addresses preventing unnecessary hospitalizations of nursing home … Read more

In a continuation of the Obama Administration's effort to extend rights to same sex couples, the Centers for Medicare & Medicaid Services (CMS) issued a new State Medicaid Director Letter 11-006 (SMDL).  There are currently federal protections against homelessness and financial ruin that apply to heterosexual couples.  The SMDL sets out steps that states are … Read more

Medicare and Medicaid, which together serve over 95 million Americans,[1] or nearly one third of the U.S. population, are our two major national public health insurance programs offering secure and stable access to health care for beneficiaries, and peace of mind for their families. Last month's upset victory by Democrat Kathy Hochul in a traditionally … Read more

As we have reported previously, President Obama signed into law Pub.L.111-148, the Patient Protection and Affordability Care Act of 2010 (PPACA), on March 23, 2010, and Pub. L. 111-152, the Health Care and Education Reconciliation Act of 2010 (HCERA), on March 30, 2010. These two laws will change both the availability of health insurance and … Read more

Medicare and Medicaid, which together serve over 95 million Americans,[1] are our two major national public programs offering secure and stable access to health care for beneficiaries, and peace of mind to the their families. Medicaid is under attack by proposals that would limit its scope and/or eliminate current program structures that provide important protections … Read more

Federal poverty level (FPL) guidelines for 2011 were published in the Federal Register January 20, 2011. 76 FR 3637 (January 20, 2011).  The guidelines provide the baseline for eligibility levels for many public benefits, including health benefits for older people and people with disabilities.[1] The published poverty levels merely state a dollar figure for different-sized … Read more

The Affordable Care Act creates an office within the Centers for Medicare & Medicaid Services (CMS) whose focus is beneficiaries who are eligible for both Medicare and Medicaid (dual eligibles). [1] Specifically, the Federal Coordinated Health Care Office (CHCO) is created for the purposes of: more effectively integrating benefits under Medicare and Medicaid for those … Read more

The state of Missouri requires Medicaid beneficiaries to be "confined to the home" in order to receive home health services provided under its Medicaid program. While this so-called "homebound" rule has been required by statute for home health services in Medicare since the beginning of the program, the Medicaid statute has never had such a … Read more

In 2006 the Centers for Medicare & Medicaid Services (CMS) created the "Point-of-Sale Facilitated Enrollment" (POS) process, administered by WellPoint. The purpose of the POS is to assist people who are dually eligible for Medicare and Medicaid (dual eligibles) in filling their prescriptions at the pharmacy if they have not yet been assigned to a … Read more

Introduction Advocates assisting Medicare beneficiaries, including those who are dually eligible for Medicare and Medicaid, should review the supportive services available under the Older Americans Act (OAA) for individuals in their homes or communities. The OAA includes a wide variety of services that may assist those receiving home health care under Medicare or Medicaid. In … Read more

Warning: this Alert may cause headaches. Those readers who have ever roamed the Serbonian Bog[1] that is Medicaid will feel right at home. THE MEDICAID BOG The so-called Medically Needy – Medicare beneficiaries whose Medicaid eligibility depends on meeting a spenddown (or share of cost) each month or quarter – are faced with difficult challenges … Read more

Guidance released recently by the Centers for Medicare & Medicaid Services (CMS) sheds new light on an issue that has created hardships for beneficiaries and challenges for advocates trying to help them. The guidance addresses two issues: balance billing of Qualified Medicare Beneficiaries (QMBs)and payment of Medicare cost-sharing for dually eligible beneficiaries enrolled in Medicare … Read more