Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert | March 18, 2021

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An Invitation from Center for Medicare Advocacy Founder and Executive Director, Judith Stein

Dear Friends, I invite you to the Center’s upcoming special event. We would be honored if you would join us to help kick off the Center’s anniversary celebrations at our 8th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture on April 1, 2021 — 35 years to the day since the Center was founded.

This year’s Summit will be a virtual program with content presented by leaders in advocacy, policy-making, medicine, and academia convening to discuss the best practices, solutions, and opportunities to advance access to comprehensive Medicare, health equity, and quality health care. The Summit, like all our work, is inspired by, and interspersed with, the real experiences and stories of beneficiaries and caretakers.

We are thrilled that Dr. Donald Berwick will present the 2021 Sen. Jay Rockefeller Lecture. Dr. Berwick is a leading advocate and thought leader for high-quality, equitable health care. He has previously served as Administrator of the Centers for Medicare & Medicaid Services

In order to make this Summit more widely available, we are continuing to offer a reduced registration fee. Please visit our 2021 Summit webpage to learn more and register.

Sincerely,

  1. Policy-Makers Should Review Overpayments to Medicare Advantage when Considering Medicare Fiscal Solvency
  2. Senate Finance Committee Hearing on Covid-19 and Nursing Homes
  3. Harmful “Public Charge” Rule Blocked Nationwide
  4. Assisted Living and Medicaid Home and Community-Based Services
  5. COVID Fact Sheets for Consumers
  6. New Aging Documentary March 24, 2021

Policy-Makers Should Review Overpayments to Medicare Advantage when Considering Medicare Fiscal Solvency

In the past, the Centers for Medicare & Medicaid Services’ (CMS) annual release of proposed Medicare Advantage (MA) payment rates  triggered a yearly ritual on Capitol Hill – the insurance industry rounded up support from lawmakers, getting them to sign on to letters protesting any reductions in MA payment rates. 

This ritual usually played out over several months, between February when proposed rates are traditionally released, and early April when they are finalized.  This year, however, the outgoing Trump Administration released the final 2022 payment amounts in January 2021. According to a January 15, 2021 CMS press release announcing the rates,

“[t]his announcement is being made nearly three months earlier than usual to provide MA organizations and Part D sponsors more time to take this information into consideration as they prepare their bids for 2022. The earlier release will help MA and Part D plans to better project and plan for 2022 plan costs, in light of the uncertainty associated with the coronavirus disease 2019 (COVID-19) pandemic.”  This is despite the fact, as articulated in a December 2020 Kaiser Family Foundation report, that “health insurers in most markets have become more profitable during the pandemic”.

With their 2022 rate increase secured, one might think the MA industry would relax their efforts to publicly pressure lawmakers to preserve MA payment rates.  But they have not been silent.

Medicare Advantage Overpayments

On February 24, 2021, America’s Health Insurance Plans (AHIP), the national association of insurance plans, issued a blog post entitled “Correcting the Record: Medicare Advantage Costs Far Less than Fee-for-Service Medicare” wherein they take issue with the way that the Medicare Payment Advisory Commission (MedPAC) has characterized payment to MA plans.  Among other claims, AHIP asserts that,

“[a] fair comparison of MA and the traditional Medicare program, or Fee-for-Service (FFS), clearly shows that spending in MA is lower than spending in the FFS program, and a better value for Americans.”  

AHIP stresses that,

“[u]nderstanding this is critical so policymakers have a clear and accurate assessment of MA and FFS spending—as well as the value derived from that spending—when considering the best approach for delivering high-quality, efficient care to the Medicare population.”

AHIP’s blog post garnered a rare rebuttal from MedPAC, which issued its own blog post on March 3, 2021, entitled  “For the record: MedPAC’s response to AHIP’s recent “Correcting the Record” blog post”.  In the post, MedPAC concluded that it,

“continues to find that Medicare pays more for beneficiaries enrolled in MA compared to similar beneficiaries enrolled in [traditional Medicare], which reflects program rules and other institutional features. Given the fiscal pressures facing the Medicare program, it is essential that Medicare pay plans appropriately so that the Medicare program and taxpayers can share in the greater efficiency in care delivery associated with MA plans.”

On March 15, 2021, MedPAC released its annual report to Congress. According to a press release announcing the report, Medicare paid MA plans an estimated $317 billion in 2020 (not including payments to cover Part D expenses).  MedPAC states:

“This level of payment reflects Medicare payments that were higher for MA enrollees than the program would have spent for similar beneficiaries in traditional FFS Medicare, continuing a long-standing trend. Using plan bid data for 2021, we estimate that MA payments will be 101 percent of FFS spending. However, for several years, the Commission has expressed concern that enrollees in MA plans have higher risk scores than similar beneficiaries in FFS because of plans’ more intensive coding practices that result in excess payments to plans. Accounting for coding intensity, in 2021, we estimate that Medicare payments to MA plans actually average 104 percent of FFS spending (quality bonuses in MA account for an estimated 2 to 3 percentage points of MA payments in 2021). Medicare payments to MA plans continue to exceed FFS spending levels, despite the fact that plan bids in 2021 decreased to 87 percent of FFS, in aggregate—a record low.

In prior work, we identified some MA policies that need immediate improvement. The Commission previously recommended in 2017 that CMS reduce excess payments stemming from plans’ coding practices, which would improve equity across plans and produce savings for Medicare. In 2020, the Commission also recommended replacing the MA quality bonus program with a value incentive program that would more accurately characterize the quality of care in MA. Currently, the Commission is assessing an alternative MA benchmark policy that would improve equity and efficiency in the MA program. [emphasis added]”

Medicare Fiscal Solvency

A renewed focus on Medicare’s fiscal solvency may partially explain the insurance industry’s pushback against consistent and overwhelming findings that Medicare payments to MA plans are higher than what the program spends for similar beneficiaries in traditional Medicare.  Last year, the Medicare Trustees projected that the Part A Trust Fund would become insolvent in 2024 (more recently, the Congressional Budget Office (CBO) has projected the date to be 2026).   Members of Congress, including those on committees with jurisdiction over Medicare, have indicated an interest in discussing the topic of the program’s finances.

Anticipating this debate, the Journal of the American Medical Association (JAMA) published a paper in January 2021 by Richard Frank and Tricia Neuman entitled “Addressing the Risk of Medicare Trust Fund Insolvency”.   The paper outlines several policy options for addressing the shortfall, including some that “would reduce payments to Medicare Advantage plans, which have experienced strong growth and relatively large margins, especially during the pandemic.”  The paper continues: “[t]he Medicare Advantage program is growing quickly and is projected to account for nearly half of all Medicare spending within the decade. Approximately 43% of Medicare Advantage spending comes from the Medicare HI Trust Fund.”

Similarly, in February 2021 the Commonwealth Fund released a series of papers entitled Options for Extending Medicare’s Trust Fund: The Commonwealth Fund Solvency Series authored by a range of experts with varying backgrounds who offer proposals to address the trust fund’s solvency. Among the range of policy proposals that explore both spending reductions and revenue gains, several of the experts point out Medicare Advantage payment as an area ripe for discussion.

Recently, the Committee for a Responsible Federal Budget, Arnold Ventures, and West Health issued a series of papers as part of a “Health Savers Initiative” aimed at exploring policy options to reduce health care costs.  One of the three issues briefs released in February 2021 exploring Medicare policy proposals is titled “Reducing Medicare Advantage Overpayments”.  The paper notes that overpayment to MA plans “stem[s] from incentives that lead MA plans to report enrollee diagnoses more completely than physicians billing [traditional] Medicare. MA plan beneficiaries thus appear sicker than they are relative to [traditional Medicare] beneficiaries, which leads to higher payments.”  The paper offers a method for adjusting coding intensity in order to tackle the overpayments, and states that:

“Addressing this problem would improve the solvency of the Medicare trust fund and reduce the federal budget deficit. Given the high and rising costs of health care, a number of bold policy changes will be needed to assure long-term affordability and sustainability. In this context, fully adjusting for MA coding practices that result in overpayment could be considered an obvious option, particularly because this problem is well known and adjustments are already made; they are just inadequate.”

We can only assume that the insurance industry is well aware of policy proposals to rein in current overpayments.  In a recent article entitled “This Latest Under-The-Radar Program Could Push Medicare Deeper Into Private Hands,”  published by the Center for Health Journalism, journalist Trudy Lieberman notes that “[b]usiness interests with deep pockets and experience profiting from Medicare Advantage plans […] will likely have plenty to say” about the solvency of the Medicare trust fund.  Lieberman notes:

“When it comes to Medicare, the Better Medicare Alliance, an organization that presents itself as a grassroots group to mask its corporate interests, has managed to gin up substantial support for in Congress for higher and higher rate Medicare Advantage increases. Two years ago, the Associated Press found that the Alliance was financed by three of the biggest sellers of Medicare managed care plans: UnitedHealthcare, Aetna, and Humana. The group is known for organizing networks of seniors across the country to talk about their positive experiences with Medicare Advantage plans.”

Recently, the Center for Medicare Advocacy has noticed that the Better Medicare Alliance (BMA) has placed paid online ads in publications such as Politico and Health Affairs, that, among other things, tout the MA program’s popularity.  One such ad touts that “Medicare Advantage isn’t just better health coverage for seniors, it’s a winning issue for policymakers. A new poll shows that Medicare Advantage has a 98% satisfaction rating and 93% of beneficiaries agree that a candidate’s support for Medicare Advantage is important to earn their vote […]”

A link in several of these BMA ads soliciting readers to “Learn More” leads to a January 2021 BMA press release announcing a poll reflecting high Medicare Advantage satisfaction.  The subheading of the press release reminds readers that “Beneficiaries report near-universal satisfaction with Medicare Advantage’s coverage, provider networks, and COVID-19 response while 93% say a candidate’s support for MA is important to their vote.”  [emphasis is original].

In case there was any doubt regarding the intended audience, the press release continues: “Three quarters (77%) of seniors on Medicare Advantage strongly oppose the federal government reducing the amount of money paid to Medicare Advantage, even if such cuts are billed as necessary to lower costs to taxpayers or reduce the national debt.” [Emphasis in original.]

And, just to make sure the point is clear for anyone who might have missed it, the release goes on to quote BMA’s leader, a former member of Congress, as saying:

“The results of this poll depict a rapidly growing beneficiary population that is highly pleased with their health coverage and ready to take action to ensure it is protected. 93% of beneficiaries said a candidate’s support of Medicare Advantage is important to their vote and 77% of beneficiaries ‘strongly oppose’ any cuts to Medicare Advantage. With these numbers in hand, Better Medicare Alliance and our grassroots beneficiary advocates will work to ensure lawmakers know that standing up for Medicare Advantage is good politics and good policy.” [Emphasis in original.]

Conclusion

For those who control the federal budget, achieving payment parity between Medicare Advantage and the traditional Medicare program should be low-hanging fruit.  But the insurance industry does not want the conversation about Medicare fiscal solvency to include the topic of Medicare Advantage overpayment.  They are clearly trying to warn policymakers to stay loyal to the private program or face the wrath of voters that they will help foment.  

There is a growing imbalance between Medicare Advantage and traditional Medicare, not only with respect to payment, but also relating to the scope of coverage and access to coverage options within the Medicare program.  Policymakers must demonstrate the courage to act on behalf of all Medicare beneficiaries and work to rebalance this growing inequity.

The Center for Medicare Advocacy is not opposed to spending more on the Medicare program; in fact, some of the policies and changes in law we advocate for could increase Medicare spending, with corresponding positive impacts for all Medicare beneficiaries.  Reining in MA overpayments will not, by itself, solve Medicare’s financing challenges.  But we cannot countenance private plans getting paid more than traditional Medicare spends on each beneficiary, particularly combined with the myriad other ways in which such private MA plans have been favored by policymakers.  Traditional Medicare should remain a strong, viable option available to all; this may not be the case if current trends continue.

As the Center for Medicare Advocacy has previously stated in in our efforts to push for parity between MA and traditional Medicare,

“instead of continuing to favor Medicare Advantage regardless of cost, we urge policymakers to advance complete equity between MA and traditional Medicare, including both the scope of services provided and programmatic spending. Wasteful spending on MA should be reinvested into the Medicare program to the benefit of all enrollees, not just those who choose to enroll in private plans.”

Senate Finance Committee Hearing on Covid-19 and Nursing Homes

Three clear themes emerged at the February 17 hearing held by the Senate Finance Committee – “A National Tragedy: COVID-19 in the Nation’s Nursing Homes”[1] – understaffing, health equity and the disparate impact of the pandemic on communities of color, and private equity ownership of facilities. Although problems of understaffing and health equity both predated the coronavirus pandemic, the pandemic exacerbated these issues and made them more visible to the entire country. Private equity ownership of nursing homes is a relatively new phenomenon that raises concerns about the need for more transparency in how facilities spend the reimbursement they receive from the Medicare and Medicaid programs. More complete data about COVID-19 cases and deaths among nursing home residents and staff at the beginning of the pandemic are also needed.

Witnesses at the hearing were:

  • Adelina Ramos, Certified Nursing Assistant, Rhode Island
  • Denise Bottcher, State Director, AARP Louisiana
  • Quiteka Moten, State Long-term care Ombudsman, Tennessee
  • R. Tamara Konetzka, Professor, University of Chicago
  • John Dicken, Director, Health Care, Government Accountability Office
  • David Gifford, Chief Medical Officer, American Health Care Association

Senators returned repeatedly to the powerful testimony of Ms. Ramos, who described the consequences of too little staffing – having to choose which of two residents to help to the bathroom and whether to feed one resident or help another – when all residents deserve and need care. She described a starting salary of $12.34 an hour for aides in Rhode Island, which results in aides working multiple jobs in order to meet their own basic needs. The Centers for Disease Control and Prevention (CDC) has reported that employees working in multiple nursing facilities helped spread coronavirus.[2]

Professor Konetzka and especially Dr. Gifford contended that the prevalence of COVID-19 in the community is key to the virus’ infecting residents and staff and that facility-based measures, such as the federal government’s star ratings, are not relevant to infections. Dr. Gifford’s written testimony, in particular, sought to shift responsibility from nursing homes, citing the nature of the virus, “changing and conflicting government guidance,” lack of testing and personal protective equipment, and community spread as circumstances beyond facilities’ control and responsibility. While understanding these factors, the Center for Medicare Advocacy has written multiple reports and CMA Alerts over the past year documenting the significance of staffing levels, ownership, and unionization in containing the impact of COVID-19.[3] 

The nursing home industry’s argument that Medicaid underfunds nursing homes is inconsistent with the widespread acknowledgement at the hearing that little is known about how facilities spend the reimbursement they receive and that, at the least, more transparency and accountability about facility spending practices are essential. 

Importantly, Senator Sherrod Brown (D-OH) included for the record a recent analysis showing that private equity acquisition of nursing homes between 2000 and 2017 resulted in more than 20,000 additional residents deaths and increased costs to the Medicare program.[4] Senator Elizabeth Warren (D-MA) noted that Genesis Healthcare, which received $665 million in COVID-related federal and state grants and loans in 2020, paid its CEO $8 million in salary and bonuses in 2020, just before he retired in January 2021.[5]

The Subcommittee on Oversight of the House Committee on Ways and Means has announced a hearing for March 25, 2021, “Examining Private Equity’s Expanded Rule in the U.S. Health Care System.”

___________________

[1] The hearing video, opening statements of Chairman Ron Wyden (D-OR) and Ranking Minority Member Mike Crapo (R-ID), and written statements of the six witnesses are available at https://www.finance.senate.gov/hearings/a-national-tragedy-covid-19-in-the-nations-nursing-homes. 
[2] CDC, “COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020,” Morbidity and Mortality Weekly Report (Mar, 18, 2020), https://skillednursingnews.com/wp-content/uploads/sites/4/2020/03/mm6912e1-H.pdf
[3] See, e.g., “New Report Documents Causes and Cures for COVID-19 Crisis in Long-Term Care Facilities” (CMA Alert, Feb. 18, 2021), https://medicareadvocacy.org/new-report-nursing-homes-and-covid/, linking to Cinnamon St. John, “Geography Is Not Destiny: Protecting Nursing Home Residents from the Next Pandemic,” https://medicareadvocacy.org/wp-content/uploads/2021/02/CMA-NH-Report-Geography-is-Not-Destiny.pdf; “Staffing is Key to Determining Whether Covid-19 Affects Nursing Home Residents” (CMA Alert, Feb. 4, 2021), https://medicareadvocacy.org/nursing-home-staffing-is-key-to-covid-deaths/; “Nursing Home Residents and COVID-19: Staffing and Quality of Care Matter” (CMA Alert, Dec. 3, 2020), https://medicareadvocacy.org/nursing-home-residents-and-covid-19-staffing-and-quality-of-care-matter/; “Nursing Facilities and COVID: Staffing Matters” (CMA Alert, Nov. 5, 2020), https://medicareadvocacy.org/nursing-facilities-and-covid-staffing-matters/; “Nursing Facilities and Covid-19 – it’s not Inevitable” (CMA Alert, Oct. 8, 2020),  https://medicareadvocacy.org/nursing-facilities-and-covid-19-its-not-inevitable/; “Study Finds Lower Mortality Rates in Unionized New York State Nursing Facilities” (CMA Alert, Sep. 17, 2020), https://medicareadvocacy.org/study-finds-lower-mortality-rates-in-unionized-new-york-state-nursing-facilities/; “Nursing Facilities Owned by Private Equity Firms Have Higher Rates of Covid Infections than Other Facilities” (CMA Alert, Aug. 13, 2020), https://medicareadvocacy.org/nursing-facilities-owned-by-private-equity-firms-have-higher-rates-of-covid-infections-than-other-facilities/; “Studies Find Higher Nurse Staffing Levels in Nursing Facilities Are Correlated With Better Containment Of Covid-19” (CMA Alert, Aug. 13, 2020), https://medicareadvocacy.org/studies-find-higher-nurse-staffing-levels-in-nursing-facilities-are-correlated-with-better-containment-of-covid-19/; “COVID Does Not Have to Lead to Deaths in Nursing Homes” (CMA Alert, Jul. 23, 2020), https://medicareadvocacy.org/covid-does-not-have-to-lead-to-deaths-in-nursing-homes/
[4] Atul Gupta, Sabrina T. Howell, Constantine Yannelis, and Abhinav Gupta, “Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes,” Becker Friedman Institute, Working Paper No. 2021-20 (Feb. 2021), https://bfi.uchicago.edu/wp-content/uploads/2021/02/BFI_WP_2021-20.pdf   
[5] “Warren Releases New Details on Genesis Nursing Home Company’s Massive CEO Payout” (Press Release, Mar. 17, 2021), https://www.warren.senate.gov/newsroom/press-releases/warren-releases-new-details-on-genesis-nursing-home-companys-massive-ceo-payout (including links to correspondence with Genesis).

Harmful “Public Charge” Rule Blocked Nationwide

The so-called “public Charge” rule allowed officials to deny permanent legal residence (green cards) to immigrants who had received or who were deemed likely to need assistance from government programs, such as most forms of Medicaid and SNAP (food stamps). Last week the U.S. Department of Justice stopped defending this Trump Administration regulation, meaning that the final judgment of a federal district court stands and the rule has been permanently blocked nationwide.

The public charge rule was essentially a wealth test on lawful immigration that ran contrary to decades of settled law and the immigration priorities of the United States. It discouraged family unification and forced families to choose between health care, food, housing, and a future in the United States. Older adults and people with disabilities were particularly disadvantaged because factors such as age, health, income and employability were used to evaluate and deny green card applications under the rule.

The Center for Medicare Advocacy had joined many partner organizations in submitting comments and amicus briefs opposing the public charge rule. We applaud the Biden Administration’s decision to stop defending this harmful rule in court. We will continue to advocate for fair and humane immigration policies that do not discriminate on the basis of age, health, wealth, or disability.

Assisted Living and Medicaid Home and Community-Based Services

Over the years, federal policy has sought to accommodate people’s preference to avoid nursing homes, if possible.  Programs such as Money Follows the Person and various “rebalancing” initiatives have enabled older people and people with disabilities to remain at home.  Medicaid no longer spends most of its long-term care (now typically called long-term supports and services, or LTSS) dollars on care in nursing facilities.  Since 2013, Medicaid has, in fact, spent more on home and community-based services (HCBS), provided through Medicaid waivers, than it has spent on nursing home care.[1]  In 2014, 53% of Medicaid dollars on long-term care ($80.6 billion) were spent on HCBS.[2] 

The assisted living industry capitalizes on the public’s interest in “non-nursing home care” and qualifies for Medicaid waivers under HCBS.  As shown below, each year, the Medicaid program spends billions of dollars paying for hundreds of thousands of residents of assisted living facilities who are eligible for coverage under various HCBS waiver programs. 

The Center for Medicare Advocacy understands and respects people’s interest in receiving non-institutional care.  However, no federal regulatory standards govern the use of HCBS money in assisted living facilities.  All direct regulation of licensing and oversight requirements is done at the state level; CMS’s involvement in assisted living is limited to reviewing reports submitted by states about their operation of HCBS waiver programs.[3]  Moreover, since Medicaid beneficiaries who use HCBS waivers are, by definition, eligible for a nursing home level of care,[4] the lack of federal standards is especially troubling. 

In March 2007, in a CMA Alert  titled “Is It Time for Federal Regulation of the Assisted Living Industry?,”[5] the Center reported that federal regulation of assisted living would probably not occur until a considerable amount of federal money paid for assisted living or states failed to regulate the assisted living industry adequately – or both.  The Center suggested, in 2007, that under either criterion, federal regulation was appropriate.

Fourteen years ago, although it was difficult to determine how much HCBS funding actually went to assisted living, the Center was able to determine that

  • HCBS “more than doubled from 15 percent [of Medicaid funding] in 1992 to 31 percent in 2002. [Note from above: HCBS accounted for 53% of Medicaid funding in 2014.]
  • In 2002, Medicaid spent $16.9 billion on HCBS waivers, including assisted living, and served 487,877 elderly beneficiaries and beneficiaries with disabilities.
  • Medicaid spending on HCBS waivers increased by nearly $8 billion (46%) between 1999 and 2002.

Federal Medicaid payments to HCBS have been considerably higher in later years, according to the most recent data available. In 2018, the Government Accountability Office (GAO) reported that in 2014, $10 billion of federal and state HCBS money (12.4% of total Medicaid HCBS spending in 2014 in all settings, which was $80.6 billion) was spent on 330,000 Medicaid beneficiaries living in assisted living facilities.[6]   

In 2020, the Kaiser Family Foundation reported that in 2016, Medicaid spent 57% of all LTSS dollars (a total of $167 billion) on HCBS (compared to nursing facilities).[7]  If 57% of Medicaid’s LTSS spending was for HCBS, then HCBS accounts for $95.19 billion of LTSS spending in 2016 (57% times $167 billion = $95.15 billion spent on HCBS).  Applying the 12.4% statistic from the GAO’s 2018 report, we can estimate that $11.80 billion was spent on assisted living through HCBS in 2016 (12.4% times $95.15 billion = $11.80 billion).

The National Center on Assisted Living reports that almost 1 in 6 assisted living residents (16.5%) relies on Medicaid (Medicaid state plan authorities; §1915(c) HCBS waivers; concurrent §1915(b) managed care waiver, or §1115 research or demonstration projects).[8]

There is no question that Medicaid spends a large and growing portion of its HCBS waiver money on assisted living ($10 billion in 2014; $11.80 billion in 2016).  As Medicaid spending increases and as more Medicaid beneficiaries rely on Medicaid for services in assisted living facilities, the need for a federal role in regulating assisted living facilities can no longer be ignored.

___________________

[1] Medicaid and CHIP Payment and Access Commission (MACPAC), “Home- and community-based services,  https://www.macpac.gov/subtopic/home-and-community-based-services/  
[2] Medicaid, Home & Community Based Services, https://www.medicaid.gov/medicaid/home-community-based-services/index.html (citing 2014 LTSS Expenditure Report)
[3] GAO, Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare Is Needed, GAO-18-179, p. 10 (Jan. 2018), https://www.gao.gov/assets/690/689302.pdf    
[4] 42 U.S.C. §1396a(a)(10)(C)(i)(III), https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html
 [5] “Is It Time for Federal Regulation of the Assisted Living Industry? (CMA Alert, Mar. 22, 2007), available at  https://medicareadvocacy.org/is-it-time-for-federal-regulation-of-the-assisted-living-industry/ 
[6] GAO, Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare Is Needed, GAO-18-179, p. 10 (Jan. 2018), https://www.gao.gov/assets/690/689302.pdf    
[7] Kaiser Family Foundation, Medicaid Home and Community-Based Services Enrollment and Spending (Issue Brief, Feb. 4, 2020), https://www.kff.org/report-section/medicaid-home-and-community-based-services-enrollment-and-spending-issue-brief/ Figure 2
[8] American Health Care Association/National Center on Assisted Living (no date) https://www.ahcancal.org/Assisted-Living/Policy/Pages/Medicaid.aspx

COVID Fact Sheets for Consumers

From the SHIP TA Center | for help with your coverage options and concerns, find your state SHIP program at shiptacenter.org

The following fact sheets are intended help consumers understand Medicare coverage related to COVID-19 and how to access care during a public health emergency.

New Aging Documentary March 24, 2021

Sponsored in part by The John A. Hartford Foundation

Our partners at The John A. Hartford Foundation along with the Gordon and Betty Moore Foundation are pleased to announce a powerful new documentary, FAST-FORWARD, debuting Wednesday, Mar. 24 at 10pm ET/9pm CT on PBS, which follows four millennials and their Baby Boomer parents through an ‘aging bootcamp’ that highlights the crucial role family conversations and planning play in aging successfully.

Narrated by Rosario Dawson, the film explores an intriguing question: “If you knew now what you’ll know then, would you change anything?”

In addition, Next Avenue has partnered with the film to produce courses and a digital toolkit of resources, including step-by-step instructions and a master checklist, designed to help viewers prepare their own aging plans.

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