Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – December 13, 2018

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  1. Health Care Sabotage Continues as ACA Open Enrollment Comes to an End
  2. Center Submits Comments Opposing Proposed “Public Charge” Rule
  3. CURE High Drug Prices Act Introduced
  4. Elder Justice "No Harm" Newsletter – Issue 10
  5. Checklist for Medicare Outpatient Therapy “Improvement Standard” Denials

Health Care Sabotage Continues as ACA Open Enrollment Comes to an End

There are only two days left to get covered!

Consumers have until December 15th to obtain health insurance through the Affordable Care Act (ACA) Marketplace. Those who need coverage should visit www.healthcare.gov to shop, compare and find a plan that meets their needs. It is important to keep in mind that ACA plans prohibit annual or lifetime limits on coverage, protect people with pre-existing conditions, and do not discriminate based on age or gender.

ACA-compliant plans also offer essential health benefits such as ambulatory services, emergency services, hospitalization, maternity care, mental health and substance abuse services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services.

Plans such as short-term limited-duration plans and association health plans are not ACA plans. As we have previously highlighted, these plans may be less expensive but they do not offer comprehensive coverage. Consumers should use extreme caution when looking at plans that do not offer the ACA’s consumer and coverage protections.

We have closely monitored actions taken by the Administration that have affected enrollment. During this Open Enrollment period, we saw:

  • The amount of time to enroll shortened again this year;
  • Healthcare.gov down for maintenance during critical periods;
  • Funding for enrollment assistance and outreach slashed; and
  • Critical enrollment assistance information removed from healthcare.gov.

Reports monitoring enrollment have shown a significant decrease this year in the number of people purchasing plans. The Administration’s actions (or inaction) have had significant impact on access to quality coverage. A new report by the Sunlight Foundation’s Web Integrity Project states that “Indeed, the overhaul of the “Apply for Health Insurance” page and the removal of the Latino outreach training guide come amid an array of Trump administration efforts to undermine the Open Enrollment period.” The removal of information about Hispanic outreach is especially concerning. A new report by the Urban Institute and the Episcopal Health Foundation, analyzing coverage in Texas shows that “61 percent of Texans without health insurance are Hispanic, compared to 24 percent white and 10 percent black. Researchers also found that nearly two-thirds of the uninsured in Texas are U.S. citizens.” The example from this one state shows the need for more, not less outreach and enrollment assistance.   

As we have stated before, voters could not have been clearer in last month’s election – they value access to comprehensive coverage. It is time they received it.

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Center Submits Comments Opposing Proposed “Public Charge” Rule

p>Under longstanding immigration policy, to be considered a “public charge” one must be likely to become primarily dependent on the government to meet basic needs. As it now stands, receiving government-issued financial assistance benefits such as Temporary Assistance for Needy Families (TANF) and Supplemental Security Income (SSI), or long-term care benefits through Medicaid, may cause someone to be deemed a public charge and therefore denied a green card or visa.

The Department of Homeland Security (DHS) recently proposed a rule that – if finalized – will greatly expand the scope of benefits that will lead an individual to be considered a public charge. Benefits such as the Part D low-income subsidy (“Extra Help”) for Medicare’s Part D drug benefit, Supplemental Nutrition Assistance (SNAP), non-emergency Medicaid, and Section 8 and other forms of housing assistance would be counted. Older adults and their families rely on these programs to stay healthy and independent in their communities for as long as possible.

The Center is opposed to this proposed rule, and joined over 216,000 other organizations and individuals in submitting comments online. The proposal would seriously harm older immigrants and their families, localities, states, and health care providers and facilities. Drafted in collaboration with other advocacy organizations, the Center added information specifically about the Medicare program, including the financial standing of beneficiaries, and the need for many individuals to rely on the Part D low-income subsidy (LIS) to cover prescription drug premiums and cost-sharing, Medicare Savings Programs (MSPs) to cover Part A and B premiums and cost-sharing, and full Medicaid to cover additional services not covered by Medicare.

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CURE High Drug Prices Act Introduced

Legislation supported by Center for Medicare Advocacy, Patients for Affordable Drugs Now, Families USA, Consumer Reports, and Public Citizen.

In a statement released today, U.S. Senators Richard Blumenthal (D-CT), Kamala Harris (D-CA), Jeff Merkley (D-OR), and Amy Klobuchar (D-MN) announced the introduction of the Curbing Unreasonable Rises and Excessively (CURE) High Drug Prices Act “to prohibit unjustified drug price increases and give the Department of Health and Human Services authority to block such increases and reimburse consumers who were harmed.”  This would be an important assist, particularly for individuals in need of multiple medications.

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Elder Justice "No Harm" Newsletter – Issue 10

Elder Justice: What "No Harm" Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a "no harm” deficiency is and what it means to nursing home residents. Our latest issue has real stories from nursing homes in New York, New Jersey, Michigan, and Washington. Some examples of “no harm” deficiencies featured in this issue include a resident being dropped onto the floor and another resident being sexually assaulted.

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Checklist for Medicare Outpatient Therapy “Improvement Standard” Denials

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for outpatient therapy based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for outpatient therapy and emphasizes language from the Jimmo Settlement Agreement. Per the Settlement, the Centers for Medicare & Medicaid Services (CMS) revised the Medicare Benefit Policy Manual to clearly disavow any notion that individuals receiving outpatient therapy must improve in order for their care to be covered by Medicare.

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