Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources.
Married seniors and adults with disabilities overwhelming want to live at home and age in place. Increasingly, federal and state Medicaid rules have prioritized home and community-based services (HCBS) which allow people to stay in their homes and in their communities. Congress recently helped these efforts by expanding a Medicaid eligibility rule, known as the spousal impoverishment protection, to individuals eligible for HCBS. The protection makes it possible for an individual who needs a nursing home level of care to qualify for Medicaid while allowing their spouse to retain a modest amount of income and resources. However, the expansion of the spousal impoverishment protection is set to expire on March 31, 2019 unless Congress acts. This means that individuals who qualified under the expanded protection may lose access to Medicaid and to their HCBS and may be left with no choice but to move into institutional long-term care, away from their spouses.
Letting the spousal impoverishment protection expire will hurt families and force more people out of their homes and their communities. We urge Congress to make the expanded spousal impoverishment protection permanent so seniors and people with disabilities can age in place and with dignity.
Justice in Aging has created a fact sheet on the importance of the expanded HCBS spousal impoverishment protection and calling on Congress to make it permanent so seniors and people with disabilities can age in place and with dignity.
More and more states are moving to restrict Medicaid coverage by requiring low-income adults to report that they are working. In fact, the list of states that are in the process of designing or implementing these so-called “community engagement” or work requirement policies has grown to seventeen. Unfortunately, these harmful policies are especially dangerous for family caregivers because they create so much red tape and ignore the stressful and often complex situations these individuals face.
Medicaid is an important source of health insurance coverage for many of the 40 million family caregivers in the United States who do not have access to other affordable coverage options. Yet states are taking away that coverage by requiring low-income adults who are eligible for Medicaid to work a certain number of hours per month or qualify for an exemption.
Low-income family caregivers may be unable to work the requisite hours at a paid job because of their caregiving responsibilities, and only 5 states explicitly count caregiving hours towards meeting the work requirement. Although every state that is implementing or planning to impose work requirements provides some exemptions for family caregivers, the majority of states limit the caregiver exemption to caring for a dependent, a relative/family member, or a household member. Requiring family caregivers to report caregiving hours or prove they are exempt to maintain their Medicaid coverage puts the greatest burden on those who already face the most stressful situations of caring for a loved one with significant and complex needs.
What makes these policies even more harmful is that the onerous and sometimes impossible reporting requirements alone are blocking coverage for individuals who are working the requisite number of hours or who qualify for a caregiver or other exemption. As we see, Arkansas, the first state to implement the policy, is creating red tape by requiring individuals to gather documentation and report compliance. Yet, the state is not communicating the requirements clearly so that people understand them, nor is it providing necessary supports, such as internet access to help people report compliance, or transportation to find or get to work.
Because of these bad policies, caregivers in Arkansas have already been denied access to the coverage they need to maintain their own health, harming both their own well-being and the well-being of the older adults they care for. Taking away Medicaid coverage from family caregivers will increase the health disparities those who are low-income, older, women, and people of color already face. It puts more older adults at risk of being institutionalized because their family or friends can no longer care for them at home and in their communities.
And many more family caregivers will be in the same dangerous situation if these policies continue to move forward. That’s why it’s critical to fight back! Tell your state policy makers and the Trump Administration the stories of the family caregivers and older adults who are being harmed, whether your state is considering such a proposal or already in the implementation stage.
Justice in Aging recently conducted a state-by-state survey of how Medicaid work requirements apply to family caregivers and wrote a report explaining how they threaten the health and well-being of family caregivers and the older adults they care for.
Inside Health Policy January 29, 2019
This story leads with the news that CMS is taking a look at medically necessary dental benefits for Medicare beneficiaries. The article then goes on to describe advocate efforts (including Justice in Aging) to push for an inclusion of oral health benefits in Medicare Part B. The article also mentions Justice in Aging’s brief on including an oral health benefit in Medicare as well as a bill that Senator Ben Cardin introduced to provide an oral health benefit. The article is behind a paywall. This is a summary.
Fewer than half of older adults have access to oral health care each year. One in five older adults has untreated tooth decay and 70 percent have gum disease. Poor oral health and lack of access to health care are even more acute for low-income seniors, seniors of color, and rural seniors. Because oral health is an integral part of overall health and untreated dental problems can cause and/or exacerbate other serious health issues, it is critical to expand older adults’ access to oral health care.
Because all older adults rely on Medicare for their health care needs, integrating oral health benefits into Medicare Part B is the most effective way to deliver comprehensive benefits to all Medicare beneficiaries. Justice in Aging’s statutory analysis shows how such a benefit could be structured and where statutory language could be changed to accommodate such a benefit.
Inside Health Policy: Cardin, Neal Express Interest in Medicare Oral Health Coverage (January 14, 2019)
Oral health is critical to overall health, yet, fewer than half of older adults have access to oral health care in a given year. In 2018, Justice in Aging contributed to a white paper released by Oral Health America. In the white paper, we discussed how incorporating an oral health benefit into Medicare Part B could expand access to oral health care to older adults.
On January 4, 2019, Senator Ben Cardin (D-MD) introduced legislation to add oral health to Medicare Part B. Justice in Aging Deputy Director, Jennifer Goldberg, was quoted in the article saying that stakeholder support is coalescing behind adding an oral health benefit to Medicare Part B. The article is available online only to subscribers of Inside Health Policy. This is a summary.
The Centers for Medicare and Medicaid Services (CMS) issued new rules that limit enrollment and disenrollment from Medicare Advantage and Part D prescription drug plans for low-income Medicare beneficiaries. Previously, dual eligibles – individuals with Medicare and Medi-Cal coverage – and beneficiaries who receive the low-income subsidy (LIS) to make Part D prescription drug coverage more affordable could make enrollment changes any time throughout the year. The new rule, which became effective January 1, 2019, limits enrollment changes to once per quarter.
Justice in Aging has created a factsheet that explains these changes in detail and how they impact low-income Medicare beneficiaries in California.
In January , 2019, Senator Benjamin Cardin introduced the Medicare Dental Benefit Act of 2019, which amends the Social Security Act to provide for coverage of dental services under the Medicare program. Oral health is a key component of overall health and this new legislation is a critical step in improving the health and well-being of older adults and people with disabilities. Justice in Aging joined with Families USA, Oral Health America, and Center for Medicare Advocacy to thank Senator Cardin for his leadership on the issue. Read the letter.
Justice in Aging has filed a class action lawsuit against Florida’s Agency for Health Care Administration. Currently, older adults and people with disabilities could wait up to 3.5 years to access in-home health care. Justice in Aging wants Florida to develop more in-home care services for people and increase the capacity of the services it has. Litigation Director Regan Bailey said “it’s a need that’s growing. And the way to meet that need is to provide more community-based services because you can serve many more people for the same money in the community versus in a nursing facility.”
Last Friday, a Federal District Court in Texas issued a decision declaring the Affordable Care Act (ACA) in its entirety unconstitutional. The judge’s reasoning has been widely criticized and legal scholars contend that it is unlikely the decision will be upheld on appeal. Nevertheless, the ruling sowed confusion and uncertainty on the eve of the ACA Marketplace enrollment deadline and furthers the harm caused by the Trump Administration’s and Congress’s actions to undermine the ACA.
If the ruling were to stand, the implications for older adults would be catastrophic. Over 4.5 million older adults age 55-64 who have coverage through the Marketplaces and Medicaid expansion would lose access to health care. For millions more, health care would become either unaffordable or unattainable because health insurance companies would again be permitted to charge older adults more based on age and deny coverage to the 8 out of 10 older adults with a preexisting condition.
The ACA’s Medicare provisions would also be rolled back. Medicare enrollees would face higher prescription drug costs and out-of-pocket spending on preventive services that are currently free pursuant to the ACA. Further, the savings from the ACA that extended the life of the Medicare trust fund would be eliminated, placing Medicare at risk for dramatic cuts through the budget, vouchers, and privatization. These are costs that seniors simply cannot afford.
Despite the judge’s ruling, the ACA remains the law today and older Americans can continue to rely on the ACA’s protections and coverage. By joining together, we have successfully prevented previous attempts strike down the ACA. That fight continues to ensure older adults have access to affordable and quality health care as they age.
When: Thursday, December 13, 2018 from 10am – 11 am PT/ 1 pm -2pm ET.
Medicaid is an important source of health insurance coverage for many of the 40 million family caregivers in the United States who do not have access to other affordable coverage options. However, many states are in the process of designing or implementing policies that require family caregivers and others who are eligible for Medicaid to work a certain number of hours per month or qualify for an exemption to maintain their health coverage. Despite “caregiver” exemptions, these burdensome work requirements will cause many family caregivers who are in fact eligible for Medicaid to lose their coverage.
This webinar highlights key findings from a new Justice in Aging issue brief. We discuss our state-by-state survey of how Medicaid work requirements apply to family caregivers and analysis of the particular harms they will cause to family caregivers and the older adults they care for.