CHA Blog

On February 17, 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act of 2009, Pub. L. No. 110-329. The Recovery Act authorizes $789 billion in new federal spending to save or create 3.5 million jobs, reduce taxes for low- or moderate-income households, help provide health coverage for people who have lost their jobs, protect Medicaid beneficiaries from state cuts, invest in the nation’s infrastructure, and more. The law contains provisions relating to Medicare, Medicaid (Medi-Cal in California), the Administration on Aging (AoA), and Social Security, including a one-time payment of $250 to each of the more than 60 million beneficiaries receiving Social Security and/or Supplemental Security Income (SSI). Below is a brief highlight of the Recovery Act’s provisions relating to these programs.

• The Qualified Individual (QI) program is extended to December 31, 2010. (The Medicare Improvements for Patients and Providers Act of 2008 – MIPPA – extended it until December 31, 2009.) This program pays the Medicare Part B monthly premium for qualified beneficiaries with low-incomes and assets.
• A 65% tax subsidy for the cost of health benefits through COBRA. COBRA, the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 (PDF) is the federal law that gives certain employees the right to continue their group health insurance when it would otherwise end.   As COBRA coverage can be quite expensive, this tax subsidy makes this continued health care coverage more affordable for the unemployed and their families. Millions of individuals, including those who previously declined employer-provided coverage under COBRA, are eligible to receive a subsidy on their premiums for up to 9 months after being involuntary terminated from their job. People who lost or lose their jobs on or after September 1, 2008 through December 31, 2009 can qualify for this subsidy. See the Department of Labor’s website for more information on the COBRA subsidy.
• A one-time payment of $250 will be sent to people who receive Social Security benefits, Supplemental Security Income (SSI), Veterans Affairs or Railroad Retirement benefits. The Administration on Aging expects all payments to be delivered by late May 2009.  People should not contact the Social Security Administration (SSA) unless they do not receive the check by June 4, 2009. Payment will not count as income when determining eligibility for or the amount of benefits under any Federal or federally funded program, such as SSI, Medicaid (Medi-Cal in California), Medicare Part D’s Low-Income Subsidy, Food Stamps or housing assistance. Also, it does not count toward the resource limit for SSI or any other Federal or federally funded program for 9 months following the date of receipt.
• Increased Federal Medical Assistance Percentage (FMAP) of Medicaid payments. The FMAP is the federal reimbursement rate for state Medicaid spending. The Recovery Act includes at least a 6.2% increase in every state’s FMAP – this will provide more federal dollars for every dollar California’s Medi-Cal program spends.
• Funding for Health Information Technology (IT) in Medicare and Medicaid. The Recovery Act requires the Federal government to take the lead in health information technology (such as electronic health records) by establishing standards for nationwide electronic exchange and use of health information to improve quality and coordination of care by 2010. The provision also invests $19 billion in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors, hospitals and other providers to use health IT for electronically exchanging patients’ health information.
• Funding for Administration on Aging provisions. The Recovery Act includes $100 million for congregate meals programs and home-delivered meals programs run by the AoA.

For more information on the Recovery Act, see:

• White House press release and fact sheets on the Recovery Act
• California’s website to track the Recovery Act’s funds for health and other efforts

This new web-based and downloadable tool guides people who are newly eligible for Medicare (either by age or having a disability) through commonly asked questions and important action steps to take to ensure they get the most of their Medicare coverage. This tool helps beneficiaries:

• Understand how to enroll in Medicare, and understand the rules for when they can delay enrollment without a penalty;
• Know if they have creditable drug coverage (either through Medicare Part D or other drug coverage);
• Know their options for supplementing Medicare;
• Be aware of low-income programs to help cover Medicare costs for those who qualify; and
• Know resources available for help and for more information on each question.

As the baby boomer population continues to age, this is a handy tool for advocates, providers and counselors to give to their clients, both those coming into Medicare due to age, and those qualifying due to a disability.

View this tool online or download the pdf version.

California state law (SB 853) requires private health plans to provide health care services in a consumer’s language. This law went into effect January 1, 2009 and is a significant step in making our state’s healthcare system and services accessible to all people, including those with limited English proficiency (LEP). 

The state’s Department of Managed Health Care, Office of Patient Advocate has some flyers in English, Spanish and Chinese to educate consumers about their rights to receive services in their own language. 

SB 853 Consumer Alert:

• English & Spanish
• Chinese

Note that due to federal preemption, Medicare Advantage (MA) plans are not required to comply with SB 853. Yet, some organizations that offer MA plans also offer non-MA plans in California, which are required to comply with SB 853.  Organizations that already have language access services set up for their non-MA plans may, on their own, set a policy to offer language services to all their enrollees, including their MA plan enrollees. Currently, Medicare standards for offering language services focus on marketing and enrollment, versus the provision of health care services.

Please help spread the information on this new law mandating language access services. Also, let us know of any cases of MA plans not providing language access to limited English proficient clients. We will use this information in our advocacy efforts.

Email us at news@cahealthadvocates.org. 

More info on language access, see:

• Are Your Services Available to Those Who Need Them?

Top 10 Most Requested Foreign Languages in California:

1. Spanish
2. Cantonese
3. Mandarin
4. Vietnamese
5. Korean
6. Russian
7. Farsi
8. Arabic
9. Punjabi
10. Tagalog

Have you heard complaints that prescriptions for metoprolol succinate ER, one of the generic versions of the beta blocker medication Toprol XL, can’t be filled due to a national shortage of the drugs? Since late last year, our country’s two biggest suppliers of this commonly used generic high blood pressure medication have slowed production to almost a halt. Novartis’s generics unit, Sandoz, recalled 6 million bottles of generic Toprol XL late last year, after the FDA sent the company a warning letter about the factory in North Carolina that makes the pills. Another supplier, KV Pharmaceutical, is experiencing economic challenges and has said it would stop making and selling all of its products, including generic Toprol XL.

Most Medicare Part D plans cover the generic version of this drug, which is cheaper for beneficiaries to use. Now, however, when local pharmacies are unable to refill prescriptions for the generic version, they call the beneficiaries’ doctors to change the prescriptions. If the prescription is changed to the brand name, the drug is either on a higher cost-sharing tier or it’s not on the formulary at all.

Advocates are receiving complaints from beneficiaries about:

1. having to pay more money for the brand name version of the beta blocker;
2. not having enough money to pay for the brand name drug; or
3. having to file an appeal to receive a version of this drug that’s not on their plan formulary.

Advocates have asked the Centers for Medicare and Medicaid Services (CMS) to issue plan guidance requiring them to cover the brand name version of the beta blocker until the shortage is resolved. CMS is currently following up on the drug shortage status. In the meantime, if you have any additional beneficiary/client complaints, stories or experiences around this issue, please share them with us and we will forward your complaints to CMS.

Here’s an article in the Wall Street Journal discussing the cause of the shortage.

For more information on Part D and/or appeals, see:

• Prescription Drugs
• Medicare Part D Appeals