This week, the Biden-Harris administration finalized several rules to improve access and quality for people with Medicare or Medicaid. These rules target long-term care facilities, Home- and Community-Based Services (HCBS), and Medicaid managed care. Together, the rules are important steps to ensure that people in these programs, especially those in Medicaid, have the care and coverage they need. The first rule establishes a minimum staffing standard for nursing homes. Establishing minimum staffing gained traction after the COVID-19 pandemic swept through nursing homes, revealing the full cost ..read more

Earlier this month, the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) released research showing how Inflation Reduction Act (IRA) provisions will lower costs for women with Medicare–including nearly 30 million women who have Part D. The ASPE data show that if the IRA’s $35 cap on cost sharing for Medicare-covered insulin had been in place in 2020, about 733,000 women with Medicare would have saved money and that in 2021, about two million women with Medicare received recommended vaccines that are now covered with zero cost sha ..read more

This week, Medicare Rights joined 47 organizations representing people with Medicare, families, advocates, and providers in a letter thanking the U.S. Department of Health and Human Services (HHS) for the advancements in the 2025 Medicare Advantage (MA) rate announcement and urging additional action to further improve plan accountability and payment methodology. The 2025 rate announcement, and in particular its continued phase-in of planned changes to the MA risk adjustment model, is a critical step forward. Once fully in place, those modifications will better align MA with current h ..read more

Yesterday, Medicare Rights Center President Fred Riccardi testified at a hearing of the U.S. House Committee on Energy & Commerce, Subcommittee on Health, titled “Legislative Proposals To Support Patient Access To Telehealth Services.” The COVID-19 outbreak spurred significant changes in Medicare telehealth. Early in the pandemic, it was clear that Medicare beneficiaries were at high risk. Policymakers responded quickly, temporarily relaxing restrictions so more beneficiaries could obtain telehealth through more types of technology, from more providers, and at more locations, tha ..read more

Late last week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule for Medicare Advantage (MA) and Part D prescription drug plans that will have a number of positive effects for enrollees and the program. This includes limiting insurance broker payments to make rates more rational and the playing field between plans more even; curtailing sales of some beneficiary information between marketing organizations; improving network adequacy for behavioral health; boosting enrollee awareness of the supplemental benefits available to them; and strengthening alignment between Medica ..read more

Last week, the Centers for Medicare & Medicaid Services (CMS) announced the 2025 payment rates for Medicare Advantage (MA) and Part D plans. The final policies largely align with those proposed in the Advance Notice and are expected to increase Medicare payments to MA plans by 3.7%—over $16 billion—next year. The Medicare Rights Center appreciates the finalization of provisions that would help rein in soaring and unnecessary MA costs, and  additional, comprehensive reforms.  The research from independent experts is clear: Medicare overpays MA plans by billions of d ..read more

As of today, 41 states and the District of Columbia have expanded Medicaid coverage to adults between the ages of 19 and 64. Georgia is one of the holdouts. Though the state has taken steps to adopt a modified expansion, that approach has been unsuccessful, rife with significant eligibility and enrollment barriers, burgeoning costs, and few enrollees. This effort began in July 2023, when Georgia launched Georgia Pathways to Coverage, a program to extend Medicaid only to applicants able to meet and document onerous work, school, or other administrative requirements. So far, the state reports th ..read more

This week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to make enrolling and staying in Medicaid easier, especially for older adults and people with disabilities. This rule is a companion to one finalized last fall that streamlined enrollment into Medicare Savings Programs (MSPs). Medicaid is a joint federal and state program with many different categories of coverage, each with its own eligibility rules and processes. These pathways include coverage for pregnant people, children, low-income adults between 19 and 64 who are not Medicare eligible (expansion Medicaid ..read more

The Affordable Care Act (ACA), passed 14 years ago this week, strengthened Medicare and Medicaid and created important coverage guarantees and consumer protections for people of all ages. From expanding access to affordable care to preventing discrimination based on health status, as well as improving Medicare’s financial status, the ACA made significant improvements to the nation’s health care infrastructure. These advances are especially important for older adults, who are more likely than younger adults to have health problems that cause them to rely on the ACA’s consumer protections. Some ..read more

Direct care workers are vital to ensuring older adults and people with disabilities can safely remain in their homes and communities. Such workers, as formally classified by the Department of Labor, include certified nursing assistants, home health aides, personal care aides, caregivers, and companions. Medicaid funds many direct care workers, including those employed by home care agencies or as compensated family caregivers. Despite their essential role and the growing demand for home-based services as the population ages, they tend to have low wages and work in challenging conditions. This m ..read more