CHA Blog

The National Senior Citizens Law Center recently published a checklist for organizations serving clients with limited English proficiency (LEP), Best Practices for Reaching Out and Serving Limited English Proficient Clients (PDF). Under federal law, all organizations receiving federal funds are required to evaluate the language needs of their clients, develop a plan to meet those needs, and notify LEP individuals of their rights to assistance. This checklist provides tips on making an organization’s office environment and culture (i.e. signage, volunteer/staff training), communications (in-person, telephone, website, and written), outreach efforts of greater benefit to LEP clients. The checklist also covers the LEP assistance requirements for Social Security, Medicare, Medicare Advantage plans and Part D prescription drug plans, and lists where to file a complaint if these requirements are not met. For more information on the federal and state laws and policies regarding organizations and agencies making their services accessible to people with limited English proficiency, see our article, “Are Your Services Available to Those Who Need Them?” Some other related articles with excellent resources include:

• Part D Struggles Stimulate Ideas to Overcome Language Barriers
• Proposed Regulations Weaken Language Access Law in CA HMOs
• Small Victory in Language Access – 2009 MA and Part D Plan Notices of Coverage Include Info on Available Translated Materials

Yesterday, on Veterans’ Day 11/11/08, Vietnam veteran, John Campbell launched a new web-based community called MyVetwork, aimed at providing support to veterans and their communities.

Campbell, Founder and CEO of this non-profit social networking site, found it challenging to locate information about support for himself and his family when returning from Vietnam. As a way to help remedy this situation for new and retired veterans, their families and supporters, Campbell created this online community to connect people with information, services, and an easily-accessible community. In brief, this social networking site both:

1. Provides US military and those who care about them with a way to interact with and support each other in ways that range from lighthearted to meaningful, long-lasting communication; and 
2. Creates an interactive exchange where a broad variety of experts – including veterans of earlier conflicts – provide timely news on military matters, job and career advice, information on educational opportunities, and advice regarding health care.

For more information on Veterans health care benefits and how they work with Medicare coverage, see our new fact sheet, “Medicare and Veterans Administration Medical Benefits Package.”

According to a recent report from California Disability Community Action Network (CDCAN), Governor Schwarzenegger is proposing major cuts that would end several optional Medi-Cal benefits and cut or reduce benefits to certain Supplemental Security Income (SSI), State Supplementary Payment (SSP) and In-Home-Supportive Services (IHSS) programs. These cuts would impact children and adults with disabilities, people with mental health needs, seniors, the blind, low-income children and families, and providers across California. Governor Schwarzenegger plans to call the Legislature back in for a special session before November 30th to address the state’s budget crisis – a budget shortfall projected to be as high as $11 billion. Governor Schwarzenegger hopes to have these proposed cuts approved by the current Legislature. This way the cuts would apply for this budget year which began July 1, 2008, and also extend through the next budget year (July 1, 2009 – June 30, 2010).  In some cases, such as with the proposed elimination of the Cash Assistance Program for Immigrants, which provides SSP level state funded grants to eligible legal immigrants who have disabilities, are blind or are over 65 years of age, would be permanent, as would the cuts proposed for IHSS and Medi-Cal.

Below are some highlights from CDCAN’s report that would affect California’s adults with disabilities and seniors:

Medi-Cal

• Proposal to reduce California Medi-Cal benefits to the level of benefits most other states’ Medicaid programs provide by permanently eliminating the following optional benefits: adult dental (excluding children), chiropractic, incontinence creams and washes, acupuncture, audiology, podiatry, and psychology Medi-Cal funded services.
• Proposal to reduce Medi-Cal benefits for newly qualified immigrants and immigrants who permanently live in California to the same level currently provided to undocumented immigrants. Medi-Cal benefits that would remain include emergency services, pregnancy related services, long-term care in nursing home facilities, and breast and cervical cancer treatments. 
• Proposal to reinstate share of cost for Medi-Cal services for persons with disabilities, people who are blind or seniors with incomes over the SSI/SSP limits.  Eligibility for Medi-Cal without a share of cost for those persons was expanded in January 2001 from 69% to up to 127% of the federal poverty level through the Aged and Disabled Federal Poverty Level program.  
• Proposal to cut emergency services for undocumented immigrants by implementing a monthly eligibility determination for emergency services for undocumented immigrants. Undocumented immigrants currently receive up to 6 months of health services after an initial eligibility determination.  The Governor’s proposal would limit those services to 1 month unless and until there is a subsequent health emergency.

In-Home Supportive Services (IHSS) 

• Proposal to cut the state’s participation (matching funds) for IHSS worker wages and benefits to the level of California’s minimum wage ($8/hour).
• Proposal to eliminate IHSS domestic and related services for some people receiving IHSS with a higher functionality.  (Note IHSS has an index to measure a person’s ‘functionality’). Would maintain those services for persons with less functionality.  Proposed effective date if approved would be March 1, 2009. 

SSI/SSP (Supplemental Security Income/State Supplemental Payment)

• Proposal to permanently eliminate the Cash Assistance Program for Immigrants (CAPI), effective (if approved) March 1, 2009. 

For more information, see CDCAN’s website for more information. 

World Institute on Disabilities’ (WID) website, Disability Benefits 101, has detailed information on Medi-Cal, IHSS and SSI/SSP.

See our website sections on Medi-Cal and other programs for people with low-incomes.

The Center for Medicare and Medicaid Services (CMS) just released information on drug claims for the 25 million Medicare beneficiaries enrolled in Medicare Part D. The Medicare Part D Data Final Rule, published in May 2008 called for the compilation of this claims data (see Final Rule fact sheet) for program monitoring, research, and quality improvement.

Below are some highlights on beneficiaries’ experiences with Part D costs and benefits extracted from this 2006-2007 claims data and presented at CMS’ Medicare Prescription Drug Benefit (Part D) Symposium on October 30, 2008. Additional information on the Medicare Part D Data Final Rule and access to the power point presentations from the symposium will be available next week on CMS’ website.

Beneficiary Experience

Part D Costs and Utilization per Beneficiary

Based on 2006 data, the average monthly cost per enrolled beneficiary (including both beneficiary out-of-pocket costs and plan costs) was $203. The average cost was higher among stand-alone prescription drug plans (PDPs) ($233) than Medicare Advantage prescription drug plans (MA-PDs) ($135). It was also slightly higher among females ($209) than males ($193), and higher among enrollees with the low-income subsidy (LIS) ($277) than non-LIS enrollees ($147).

The average number of prescriptions per enrolled beneficiary per month was 3.2. The average number of prescriptions per enrolled beneficiary was slightly higher among PDPs (3.5) than MA-PDs (2.5), slightly higher among females (3.5) than males (2.8), and higher among the LIS (4.1) than the non-LIS enrollees (2.6).

Beneficiaries who Reached the Donut Hole Coverage Gap or Entered the Catastrophic Coverage Phase

According to CMS data, a smaller percentage of total enrollees were fully exposed to the Part D donut hole coverage gap (10.9%) as opposed to the 26% of beneficiaries reported in the recent Kaiser Family Foundation report. This smaller percentage was calculated after excluding all LIS beneficiaries as well as those non-LIS beneficiaries with some type of coverage in the gap.

When taking out these exclusions, however, CMS data actually shows a greater percentage than the KFF report – 31.7% of all enrolled beneficiaries – who fall into the donut hole.

Also, CMS found it took affected beneficiaries an average of 6 months from enrollment time to reach the donut hole. The average time in the donut hole was about 4 months. In both years, on average, LIS enrollees reached the donut hole sooner than non-LIS enrollees and PDP enrollees reached the donut hole sooner than MA-PD enrollees.

In addition, only 8.8% of all Part D enrollees reached the catastrophic coverage phase in 2007, and the vast majority were LIS beneficiaries.

See more information on Medicare Part D claims data on CMS’ website.

For information on the Part D donut hole and resources for people who are in the coverage gap, see our:

• Article “Need Help in the Part D Donut Hole? – A Review of PAPs and the Co-Pay Relief Program” and
• Resources for prescription drug savings.

For more information on the Medicare Part D benefit and extra help (LIS program) for people with low-income, visit the Part D section of our website.