JustCare

Category: Medicaid

  • Trump pardons several Medicare fraudsters

    Trump pardons several Medicare fraudsters

    Fred Schulte of Kaiser Health News reports that Donald Trump, on his way out of office, granted pardons or commutations to several Medicare fraudsters. Many of these convicts were serving long jail sentences for major crimes. Who knows what Trump received in exchange for giving these serious criminals their freedom back.

    One man was allegedly responsible for thousands of questionable spinal surgeries. Another man allegedly ripped off Medicare and Medicaid to the tune of $1 billion taken from senior care facilities. All of those pardoned put the lives of vulnerable older adults at risk and ripped off taxpayers.

    Trump said that Senator Robert Menendez of New Jersey and Congressman Mario Diaz-Balart of Florida supported his decision to pardon Salomon Melgen. Melgen was an eye doctor in Florida convicted of defrauding the government of $100 million. He was charged with giving unnecessary treatments to his patients and compromising their health. Trump’s stated rationale: “Numerous patients and friends testify to his generosity in treating all patients, especially those unable to pay or unable to afford healthcare insurance.”

    Trump also pardoned a former doctor and who was an owner of Pacific Hospital of Long Beach, serving a 15-month prison sentence. He was found to have been paying thousands of dollars in kickbacks to doctors who sent patients to Pacific Hospital of Long Beach for unnecessary surgeries.

    Sholam Weiss received a pardon from Trump. He was sentenced to 835 years in federal prison for what some say is the longest sentence every for racketeering, wire fraud, money laundering and obstruction of justice. Trump said that time served–18 years of prison–was enough.

    Trump pardoned John Davis for his crime of accepting over three-quarters of a million dollars in illegal bribes linked to fraudulent Medicare bills of $4.6 million. In Trump’s view, the former CEO of Comprehensive Pain Specialists, a chain of pain management clinics in Tennessee, committed a single crime that did not lead anyone to suffer financially. He belonged home with his three young children after serving four months in jail.

    Here’s more from Just Care:

  • CMS rule would make prior authorization easier for people in most federal programs, except Medicare Advantage

    CMS rule would make prior authorization easier for people in most federal programs, except Medicare Advantage

    People in Medicare Advantage plans–the private health insurance plans that offer Medicare benefits–contend with multiple challenges to getting care, including restricted networks of doctors, high deductibles and copays, and prior authorization rules. Healthcare Dive reports that the Centers for Medicare and Medicaid Services just issued a rule that would make prior authorization easier for people with Medicaid, people in state health insurance plans and people in the CHIP program beginning January 2023. For some incomprehensible reason, the rule does not apply to people in Medicare Advantage.

    As you might expect, the hospitals, doctors and patients generally like the proposed rule. It would standardize and speed up the approval process for the delivery of health care services and medicines, reducing the burden on them. It would means shorter delays in the delivery of care.

    But, the providers do not understand why it does not include Medicare Advantage plans. Why shouldn’t they be part of a CMS rule that standardizes data-sharing? They cover millions of people. Not having them included only complicates matters for providers and makes it harder for older adults and people with disabilities enrolled in Medicare Advantage to get care.

    What’s problematic about the new rule is that it gives health plans–except for health plans in the state health insurance exchanges–as long as seven days to make a decision about whether to authorize a standard procedure. Even when the procedure is urgent, the insurers have three full days.

    Why should health insurers have so much power to delay care and jeopardize people’s health, even in an urgent situation? The American Hospital Association has asked that the timelines be changed to three days in non-urgent situations and 24 hours in urgent cases.

    Health insurers, for their part, are not happy with the rule whatsoever. Prior authorization allows them to delay care. At times, it deters people from getting care altogether. Anytime that care is delayed or foregone, the insurers do not spend money and profit.

    The new policy also requires insurers to let hospitals and doctors know why they are denying authorization. The insurers complain that the burden is all on them.

    The health insurers don’t have much of an argument. They claim “distraction” from containing the pandemic. They also claim that the comment period is too short to enable them to comment appropriately. They say it violates the Administrative Procedures Act.

    It’s all hogwash, but that doesn’t mean that the health insurers won’t be able to wield their enormous power to undo the rule. The question is whether the health insurers are more powerful than the doctors, the hospitals and the patients. Most likely yes, since they have more resources.

    The rule would force more electronic interoperability among providers and insurers. For all kinds of reasons, the improved ability to exchange data is important.

    Here’s more from Just Care:

  • Blame President Trump if people with pre-existing conditions lose their health insurance guarantee

    Blame President Trump if people with pre-existing conditions lose their health insurance guarantee

    In an op-ed for the New York Times, former Administrator of the Centers for Medicare and Medicaid Services, Andy Slavitt, and Nicholas Bagley explain how President Trump will be to blame if the new Supreme Court overturns the Affordable Care Act. With Ruth Bader Ginsburg’s passing, extra benefits for people with Medicare very well might fall away as might the guaranteed right to health insurance for people with pre-existing conditions.

    President Trump is supporting a lawsuit challenging the constitutionality of the Affordable Care Act. His Supreme Court nominee easily could be the deciding vote eliminating the law. If overturned, nearly 15 million people who have Medicaid as a result of the ACA’s expansion of the Medicaid income limit would lose it. And, more than 11 million people who have coverage through the state health insurance exchanges would lose that. People with Medicare Part D would have to spend a lot more for their prescription drugs.

    All Americans with health insurance would lose the guarantee of preventive care services with no deductible or copay, a protection in the ACA. They would also lose the guarantee of no lifetime limits on their coverage. And, children would not be able to get coverage through their parents’ policies until the age of 26.

    The Supreme Court case challenging the ACA is based on the nonsensical claim that because people can no longer pay a penalty as an alternative to buying health insurance–a federal appeals court struck down the penalty provision in the law–the law forces people to buy health insurance, which is unconstitutional. The plaintiffs claim that without a penalty on people who don’t buy health insurance, the language in the law that says people “shall” buy health insurance has no meaning. Of course, eliminating the penalty actually makes it less costly to decide to go without health insurance and was never meant to force people to buy health insurance.

    Plaintiffs further claim that if one part of the law is unconstitutional, the whole law is unconstitutional. This is yet another ridiculous argument. But, President Trump stands behind it. In the meantime, he has made it harder for people to get and stay on Medicaid by requiring people to complete more paperwork.

    Congress could fix the ACA. It could put a $1 financial penalty on people who don’t get health insurance. Or, it could eliminate the “shall” language from the law, so that it can’t be argued that people must buy health insurance. But, these fixes are only possible if the Democrats win control of the Senate and the presidency.

    Here’s more from Just Care:

  • Coronavirus: Lawmakers ignore horrific number of nursing home deaths

    Coronavirus: Lawmakers ignore horrific number of nursing home deaths

    David Dayen writes for The American Prospect on the horrific number of deaths at nursing homes during this novel coronavirus pandemic. At last count, more than 31,000 nursing home residents had died from COVID-19. What’s shocking is that lawmakers are turning a blind eye to the issue and protecting nursing home owners.

    First, we have incomplete and inaccurate information about nursing home deaths. In fact, only four in five nursing homes have reported COVID-19 casualties to CMS. It’s unclear how many are misreporting their data.

    At a minimum, one in four COVID-19 deaths are in nursing homes. To put that in context, nursing home residents represent fewer than one in 165 Americans. Dayen says that the number of nursing home deaths translate to between 12 and 18 deaths each hour.

    This is criminal. Horrific. But, there is not the due uproar and focus on this scandal because it is largely hidden. We are not seeing the images to trigger the needed response. We only recently have seen data.

    Meanwhile, states have imposed rules on nursing homes regarding testing of residents and staff to help contain the spread of the novel coronavirus. In some states, staff are expected to be tested twice a week. Some insurers are refusing to pay for these tests, which are related expressly to employment and not personal health. Nursing homes say they cannot afford to pay for them. Again, a guaranteed, universal health care system could easily address this issue.

    On a separate note, lawmakers have given nursing home executives immunity from liability for failing to properly care for their residents. Nursing home regulations have been loosened. Fines for failing to abide by regulations have been lowered. Yet, many nursing homes have been cited for endangering their residents over the last decade, including improper care, abuse and theft of resources.

    We have a terrible long-term care system in this country that is desperately in need of fixing. It’s long past time to start remedying this abhorrent situation.

    Here’s more from Just Care:

  • Coronavirus: Watch out for Medicare fraud

    Coronavirus: Watch out for Medicare fraud

    Ricardo Alonso-Zaldivar reports for AP that fraudsters are trying to sell older adults and people with disabilities fake coronavirus tests, along with other products and services. They want your personal information. Watch out for these scam artists!

    The US Department of Health and Human Services Office of the Inspector General is witnessing schemes in which scammers offer older people COVID-19 tests as well as “Senior Care Packages.” Some scammers say they have a vaccine, even though no vaccine exists. Some say that President Trump is requiring testing for all older adults and tell you they need your Medicare number, another falsehood.

    The scammers’ goal is to get your Medicare, Medicaid or Social Security number and other personal information. They then use the numbers fraudulently to bill Medicare and other programs for a range of services you don’t need.  If you end up needing those services at a later date, you might have difficulty getting them. Moreover, this raises health care costs and taxes for everyone.

    You should beware of scammers who reach out via phone, social media, or email, as well as scammers who make personal visits. You should know that Medicare will never call you or visit you out of the blue; it will never ask for your Medicare number; it will never try to sell you anything.

    No matter who it is who reaches out, do not release your personal information, even if you think it’s someone who sounds exactly like your child or grandchild. If it’s a call, hang up. If it’s an email, simply delete it. Do not respond.

    Keep in mind that scammers have sophisticated technology to impersonate others. If it’s someone you think you know trying to sell you something or asking for your personal information, to confirm, call the person back and use the phone numbers you have in your contact information.

    You should report fraud to the HHS inspector general’s hotline 800-HHS-TIPS or the National Center for Disaster Fraud hotline is at 866-720-5721.

    Here’s more from Just Care:

  • Here are ways Congress can ensure the well-being of older adults during the coronavirus pandemic

    Here are ways Congress can ensure the well-being of older adults during the coronavirus pandemic

    Congress has just passed an $8 billion emergency spending package to help address the coronavirus pandemic. The emergency spending package includes funding to develop a new coronavirus vaccine. It also includes funding to states and localities for emergency stockpiles to respond to people’s needs. In addition, the Trump administration has expanded telehealth services for people with Medicare and is giving the states permission to loosen Medicaid eligibility requirements. As Congress works on a large stimulus package, Senators Jack Reed, Bob Casey and many other lawmakers have set forth a list of additional actions the federal government should be taking to ensure the well-being of older adults. It is fully captured in this bill introduced by Senator Bob Casey.

    Congress should provide funding to cover the cost of automatically enrolling low-income older adults and people with disabilities in programs that help cover the cost of their premiums, deductibles and coinsurance. Today these Medicare Savings Programs are underenrolled, in part because people are not aware they are eligible. Enrolling them automatically will ensure that financial barriers do not prevent them from getting treated for the coronavirus and other health care needs.

    Congress should make it easier for older adults to get  tested and treated for the coronavirus and obtain the medicines they need. People should not forego care because of cost. Deductibles and copays should be waived along with prior authorization requirements. People should also be able to get 90-day supplies of their medicines and telehealth services. Whether you are enrolled in traditional Medicare or Medicare Advantage, you should have no out-of-pocket costs for testing. Medicare Advantage plans, including UnitedHealthcare, do not appear to be waiving out-of-pocket costs for treatment as of now.

    Congress should increase funding to survey and inspect nursing homes. The Centers for Medicare and Medicaid Services needs money to inspect these facilities and ensure they have protocols both to prevent the coronavirus from spreading and to treat cases as they emerge. Right now, people in nursing homes are at particular risk of contracting the coronavirus because of lax infection control policies in many nursing homes.

    Congress should provide states with additional Medicaid funds to help ensure low-income older adults have better  access to home and community-based services. States could then hire more direct service providers and home health workers, pay them appropriately, and provide care to people currently on wait lists.

    Congress should provide funding to Meals on Wheels and congregate meal programs to ensure older adults have healthy food to eat at home. Since older adults should be staying home as much as possible, they will not be as likely to be getting their meals at senior centers. Meals on Wheels also provides some companionship for older adults, an additional benefit that helps address social isolation.

    Congress should increase funding for the Commodity Supplemental Food Program so that it can help more at-risk older adults.

    Congress should provide funding to the National Family Caregiver Support Program so that it can help more caregivers. This program helps gives caregivers a break from their caregiving responsibilities.

    Here’s more from Just Care:

  • Trump administration acts to address some needs of older adults during the coronavirus pandemic

    Trump administration acts to address some needs of older adults during the coronavirus pandemic

    With the coronavirus spreading quickly in the US and few federal efforts to date to contain it, the Trump administration is acting to address some of the health care needs of older adults. Specifically on the health care front, it is giving the states greater flexibility to manage Medicaid and make it easier for older adults to receive telehealth services. The administration is also supporting federal legislation that would give cash payments to all Americans.

    The Trump administration now recognizes that the health of older adults, and people with low-incomes, along with every other American, is on the line. And, smart action can protect the public health. China’s coronavirus containment policies, including facilitating testing and treatment, has kept the number of people infected with the virus from growing. Yet, it continues to grow exponentially in the US and in many other countries.

    To help slow down the spread of the virus and help get older adults and people with low-incomes health care, states can opt to simplify the process for enrolling in Medicaid and expand their Medicaid provider networks. They can seek a special federal waiver called an “1135 waiver.” Florida and California are already acting to get these 1135 waivers and many other states are in process.

    In addition, Medicare is now covering a broad array of telehealth services so that older adults can get care without having to leave their homes. Until now, Medicare only covered a limited number of telehealth services in special circumstances, for example, for people in rural communities.

    The Centers for Medicare and Medicaid Services has also waived the requirement that people have prior relationships with a particular doctor in order to receive telehealth services–remote care via telephone or internet– from a doctor. Moreover, HIPAA privacy rules have been relaxed so that doctors can “see” patients via FaceTime and Skype without fear of being penalized.

    Lastly, the Trump administration is now recommending federal legislation that would have the federal government provide direct cash payments of $2,000 in two installments (on April 6 and May 18) to all Americans with incomes under a certain level which would help them pay their rent and buy basic necessities. Congress is working on a $1 trillion stimulus bill, $500 billion of which would cover the cost of these payments. The rest would support small and large businesses and more.

    Here’s more from Just Care:

  • Trump confirms his plan to cut Medicare, Social Security

    Trump confirms his plan to cut Medicare, Social Security

    If you value your Medicare and Social Security benefits as much as the vast majority of Americans, you should know that last week President Trump said  that he plans to slash them. Aaron Ruper reports for Vox News that during a town hall meeting, Trump said that he will cut Medicare and Social Security in order to reduce the national debt. Trump’s tax cuts for the wealthy and corporations has led to the largest national debt in history.

    Specifically, Trump said that cutting Medicare and Social Security would be part of his agenda, if reelected. He agreed with a reporter that he would need to cut these programs to address the national debt. Trump also promised not to cut these critical programs when he campaigned for president. So, his administration is now trying to walk back his recent statement.

    To be sure, the Republican Party has been working hard to cut Medicare and Social Security however it can. And, it has succeeded at underfunding the Social Security Administration, making it harder for people to secure benefits, particularly people applying for Social Security Disability Income (SSDI). But, Americans overwhelmingly support these programs and the vast majority want to expand them or keep them as they are.

    Now, Trump is again saying that he will “protect your Social Security and Medicare, just as I have for the past 3 years.” He is denying that he said he plans to cut them, even though he is on video saying he plans to cut them in his second term. In fact, his proposed 2021 budget includes cuts to Medicare, Medicaid and Social Security.

    As the Wall Street Journal reported: “The White House proposes to cut spending by $4.4 trillion over a decade. Of that, it targets $2 trillion in savings from mandatory spending programs, including $130 billion from changes to Medicare prescription-drug pricing, $292 billion from safety-net cuts—such as work requirements for Medicaid and food stamps—and $70 billion from tightening eligibility access to disability benefits.”

    Fortunately, House Democrats have prevented Trump’s proposed cuts to Medicare and Social Security from becoming law. So long as the Democrats control the House, they will continue to prevent Trump’s proposed cuts from becoming law. There is a lot riding on the outcome of the 2020 election.

    Here’s more from Just Care:

  • Many middle-income older adults will be unable to pay for housing and health care

    Many middle-income older adults will be unable to pay for housing and health care

    A new paper in Health Affairs projects that many middle-income older adults will not be able to afford housing and health care a decade from now. The researchers focus on the plight of middle-income older Americans over the age of 75, who represent 40 percent of the population of people over 75.

    By the researchers’ estimate, in ten years time, more than half of middle-income older adults between the ages of 75 and 84 will not have the means to move into an assisted living facility or other supportive housing when they need to. Overall, middle-income older people have annual incomes between $25,001 and $74,298. They are generally too well off to qualify for Medicaid and yet not wealthy enough to afford the costs of supportive housing. In 2029, half of them, nearly 5.5 million, will have $60,000 or less to spend each year, including their home equity. But, the average annual cost of housing and medical care is estimated to be $62,000.

    The number of middle-income older adults between the ages of 75 and 84 is projected to grow substantially by 2029, from 5.57 million in 2014 to 10.81 million in 2029. Overall, the population of middle-income adults over 75 will grow from 7.9 million in 2014 to 14.4 million by 2029. They will represent 43 percent of the total population of adults over 75.

    Medicare does not cover supportive housing or long-term services and supports. Medicaid  generally covers these services for people with low incomes. Only a small fraction of middle-income earners (about 700,000) spend down their income and assets to qualify for Medicaid.

    As the number of adults over 75 increases and their retirement income diminishes, there will be a greater need to help these middle-income older adults. Today, about 14 percent of them (1.11 million) live in supportive housing or a nursing home. Of those who live at home (1.68 million), about 25 percent of them need caregiving help. Yet, there will be fewer family caregivers. How will they get needed housing and care?

    Medicare for All would fund long-term services and supports, as well as vision, hearing and dental services, while adding little to overall national health care spending. It would also give people the freedom to see the doctors they want to see and eliminate premiums, deductibles and coinsurance, guaranteeing health care for all.

    Here’s more from Just Care:

  • Medicare and Medicaid: How they work together

    Medicare and Medicaid: How they work together

    Nearly 12 million people with Medicare also are enrolled in Medicaid. If you have Medicare and Medicaid… What does each cover? Who does it cover? It’s important to know how they work together.

    Medicare is the federal program to help older adults (65 years and older) and people with disabilities pay for medical care. Because Medicare typically covers about half of a person’s health care costs, people with Medicare generally have extra coverage that fills the gaps.  People get this extra coverage from a former job, or they buy it from a health insurer or get it through Medicaid.

    Medicaid is a joint federal and state program. People with incomes and assets below set levels qualify for Medicaid. Medicaid may cover dental, vision, and hearing and long-term care services that Medicare does not cover. People with both Medicare and Medicaid, sometimes called “dual eligibles” have lower incomes and fewer assets than people who do not qualify for Medicaid. More than 85 percent of people with Medicare and Medicaid have annual incomes below about $16,500.

    Many states let people with Medicare (and others) “spend down” to Medicaid eligibility levels if their income is otherwise too high to qualify. These states let you reduce your income by the amount of health care costs that you pay for out of pocket. If your income then meets the Medicaid eligibility limit, you will qualify for Medicaid. Call your Medicaid office to see if your state has a Medicaid “spend-down” or “excess income” program and how to qualify. (Depending upon the rules in your state, you may go on and off Medicaid at different times during the year; and, you may be eligible for different types of Medicaid benefits, including home and community-based care.)

    People with Medicaid automatically qualify for Extra Help. If you spend down to Medicaid, depending upon your income, some or all of your Medicare Part D premiums, deductibles and copays, will be covered from the month you qualify for Medicaid through the end of the year.

    If you have both Medicare and Medicaid, Medicare pays first. Medicaid picks up health care costs that Medicare does not pay. To have your costs covered in full, you must see doctors who take both Medicare and Medicaid.

    People with Medicare and Medicaid–about one in five people with Medicare–tend to have greater health care needs than the general Medicare population. They are more likely to have chronic illnesses as well as cognitive and functional impairments. They also tend to need more hospital and long-term care.

    It is difficult to predict your future health care needs. Your income and assets may be too high to qualify for Medicaid, but not so high that, if you needed costly care, you could spend down to Medicaid eligibility levels. If so, call your local State Health Insurance Assistance Program or your Area Agency on Aging about planning ahead to qualify for Medicaid. You might want to contact an elder law attorney. In some states you can set up a “Special Needs Trust” or another kind of trust that permits you to put some of your income and assets in the trust. You may then qualify for Medicaid because that income and those assets are not counted for purposes of qualifying for Medicaid.

    Here’s more from Just Care: