In October 2012, the Center for Medicare Advocacy announced the settlement of the “Improvement Standard” class action lawsuit, Jimmo vs. Sebelius. For more than thirty years, the wrongful interpretation of the Medicare statue led to the illegal denial of Medicare coverage and health care for tens of thousands of Medicare beneficiaries on the grounds that their conditions were stable, chronic, not improving, or only required “maintenance services.” Here are some of their stories.
Lead plaintiff in the Improvement Standard case, Glenda Jimmo of Bristol, Vermont is blind and has had her right leg amputated due to complications from diabetes. She requires a wheelchair, and receives multiple home health care visits per week for various treatments for her complex condition. However, Medicare denied coverage for these services, saying that she was unlikely to improve.
Rosalie Berkowitz (shown in image to the right) has multiple sclerosis and has been repeatedly denied Medicare coverage for home health physical therapy and home health aides, because her condition was not improving. If she does not receive home care, she will be forced to leave her home and enter a nursing home – where the skilled care would be covered.
"My husband is one of the few remaining World War II veterans who served in both the Atlantic and Pacific theaters. He joined the U.S. Navy right after Pearl Harbor and even served in the Battle of Iwo Jima. He has suffered from Parkinson's disease for several years, and he recently fell in our home. After he was released from the hospital, he was transferred to a skilled nursing facility. After some time, his Medicare coverage was terminated because he was not 'improving.' We have already appealed multiple times."
"I was a practicing physical therapist who left the health and nursing home field and began practicing law because of this very issue – I was being forced to discharge clients much sooner than they should have been, and their coverage would decline without skilled care, but it wouldn’t be covered since they were not 'making progress.' I refused to be a part of this system and resigned."
"These changes [from the Jimmo Settlement] are extremely meaningful, as my mother has repeatedly been denied the ability to continue the physical therapy she needs in order to prevent further deterioration of her condition. It has been extraordinarily frustrating, and after the last cessation of PT and subsequent deterioration actually endangered her life, her quality of life was greatly affected, resulting in extremely expensive 24/7 care. If she could have kept her PT services, this would not have happened!"
-Veronica, New Hampshire
The Center for Medicare Advocacy, Inc., established in 1986, is a national nonprofit, nonpartisan organization that provides education, advocacy and legal assistance to help older people and people with disabilities obtain fair access to Medicare and necessary health care. We focus on the needs of Medicare beneficiaries, people with chronic conditions, and those in need of long-term care. The organization is involved in writing, education, and advocacy activities of importance to Medicare beneficiaries nationwide. Photo Credit: Joshua Bright for The New York Times