CHA Blog

The Social Security Administration will repay more than $500 million in benefits that were illegally withheld from 80,000 people whose benefits have been suspended or denied since January 1, 2007.  SSA’s agreement to pay these funds is part of a class action settlement that was granted final approval last week by a U.S. District Court Judge.  In addition, people whose benefits were suspended or denied between 2000 and 2006 will be notified of the new policy and given a chance to re-establish eligibility. In total, over 200,000 people may see their benefits reinstated and/or receive back payments due to the settlement. All beneficiaries must continue to be eligible for benefits in order to receive payments.

The settlement resolves a lawsuit, Martinez v. Astrue, challenging SSA’s method of implementing a narrowly drawn provision of the Social Security Act.  The law aims to prevent people from using government benefits to escape arrest.  Yet rather than figuring out which Social Security recipients were actually fleeing prosecution, SSA used a computer matching system that matched names in warrant databases to those at SSA.  Many of the matches and automatic benefit suspensions involved false or unproven allegations, minor infractions or long-dormant arrest warrants. Although regulations provide for an appeal process, individuals losing benefits were routinely, inaccurately informed by SSA staff that they could not appeal.

Under the agreement, SSA has stopped, as of April 1, 2009, suspending or denying benefits due to the mere existence of a warrant – unless the warrant is issued in a criminal proceeding on a charge such as flight or escape.  This change in policy will benefit thousands of additional people every month from now on.

Note: this case/settlement does not apply to beneficiaries whose benefits were suspended or denied due to suspected parole or probation violation.

This agreement will take full effect as of November 30, 2009. Delivery of relief to class members will occur in 2010 and beyond. Class members should confirm their correct address is on file with the SSA, thus ensuring they receive the mailings when sent out next year.

National Senior Citizens Law Center (NSCLC), pro bono counsel from the law firm of Munger, Tolles & Olson, the Mental Health Project of the Urban Justice Center, Disability Rights California, and the Legal Aid Society of San Mateo County all represented the plantiffs in this case.

See NSCLC’s website section on the Martinez Settlement for more information.

This article was edited in part from NSCLC’s press release and current update.

This week the U.S. Health and Human Services Department (HHS) cracked down on Medicare Advantage (MA) organizations for their “massive misinformation campaigns” to beneficiaries. A recent article in the Huffington Post specifically highlights Humana and the letter (PDF) they sent last week to their plan enrollees claiming that Congress and the President are considering proposals to cut “important benefits and services” of Medicare, thereby jeapardizing their coverage.

HHS has mandated Humana to cease all such mailings and to remove any such information from their website immediately.

Medicare Advantage (MA) plans are specifically barred from using plan-related communications to lobby for policies or legislation. They are also supposed to only talk about an enrollee’s current benefits, or determined benefit changes that are soon to occur, not about changes that may occur.

The Centers for Medicare and Medicaid Services (CMS) sent an official memorandum to all MA organizations and Medicare Advantage Prescription Drug (MA-PD) organizations stating:

CMS has recently learned that some Medicare Advantage (MA) organizations have contacted enrollees alleging that current health care reform legislation affecting Medicare could hurt seniors and disabled individuals who could lose important benefits and services as a result of the legislation. The communications make several other claims about the legislation and how it will be detrimental to enrollees, ultimately urging enrollees to contact their congressional representatives to protest the proposals referenced in the letter.

Our priority is ensuring that accurate and clear information about the MA program is available to our beneficiaries. Thus, we are concerned about the recent mailings as they claim to convey legitimate Medicare program information about an individual’s specific benefits or other plan information but instead offer misleading and/or confusing opinion and conjecture by the plan about the effect of health care reform legislation on the MA program and other information unrelated to a beneficiary’s specific benefits.

David Lipschutz, our staff attorney, who has often voiced concern on the way Medicare providers communicate with Medicare plan members about political matters, said that: “While recent examples are more blatant than in the past, over the last few years the insurance industry has tried to convince Medicare private plan enrollees to join ‘grassroots’ organizations that are designed to protest any cuts to Medicare Advantage plan payments, sometimes using misleading and/or inaccurate rhetoric. We hope that this broader practice is also prohibited.”

If you hear of any other plans sending similar letters and messages to beneficiaries as Humana, please let us know. You can contact David Lipschutz directly at .

As Congress is planning a major overhaul of our country’s health care system, this week KQED’s Health Dialogues program is taking a closer look at home. This program, airing on Thursday 9/17, will examine the health effects of the state’s budget cuts. Those of you living in San Francisco and Sacramento areas, the airing and rebroadcasting times are:

• Thursday, 9/17 at 8 p.m.
• Friday, 9/18 at 2 a.m.
• Saturday, 9/19 at 2 p.m.

For those of you living in other areas of the state, check your local listing to find out when Health Dialogues broadcasts in your city.

A federal district court judge issued an order on 9/10/09 blocking California’s budget reductions to Adult Day Health Care (ADHC) services, marking a substantial victory for disability and senior rights advocates and thousands of California beneficiaries using ADHC. Earlier this summer, the Governor had signed budget revisions reducing the amount of days covered for ADHC services from 5 to 3 days per week, a 40% reduction. This cut would have forced many people who are able to live in the community due to ADHC services into institutionalized settings. Federal District Court Judge Saundra Brown Armstrong said that the cuts would likely be in violation of the federal Americans with Disabilities Act and Section 504 of the federal Rehabilitation Act, and therefore issued a preliminary injunction – or temporary order – to stop the cuts until appropriate replacement services are in place.

The case was filed on behalf of persons who use Adult Day Health Services, by Disability Rights of California (formerly Protection and Advocacy, Inc), the National Seniors Law Center and AARP Foundation Litigation.

The federal Judge’s Order (copy of the entire 24 page order) is available on the California Disability Community Action Network (CDCAN) website.

The H1N1 virus vaccine will be provided to Medicare beneficiaries as an additional Part B preventive immunization service. Medicare typically pays for only one vaccination per year, unless additional vaccines/doses are medically necessary. The Influenza A (H1 N1) vaccine qualifies as an additional medically necessary vaccine. If the H1 N1 vaccine requires more than one dose, additional doses will also be covered.

Note that Medicare will pay for the vaccine’s administration fee only, not the vaccine itself as these vaccines are being given to providers free of charge. Also, the provider administration payment rate will be the same as that for the seasonal influenza virus vaccine covered under Medicare’s Part B preventive immunization services.

If a Medicare beneficiary receives the H1N1 vaccination from a non-Medicare provider,  Medicare will reimburse the beneficiary up to the approved amount for the administration cost only. To receive reimbursement, the beneficiary must submit a CMS Form 1490S to their local Medicare contractor. In California the Part Medicare Part B contractor is Palmetto GBA. The CMS form must be sent to:

• J1 MAC Palmetto GBA, P.O. Box 1051, Augusta, Georgia 30903

Learn more about Medicare’s coverage of H1N1 (PDF) and payment to providers. (Center for Medicare and Medicaid Services (CMS) bulletin)

Read general information on Medicare covered services.

We recently had a good question come to our office regarding unemployment benefits and eligibility for the Part D low-income subsidy (LIS). Below is the question along with the short and long answer.

Question: Do state unemployment benefits count as income for determining LIS eligibility?

Short answer: Yes, state unemployment benefits do count as income for LIS eligibility.

Long answer: The definition of income for  the low-income subsidy is the same as for Supplemental Security Income (SSI), which is “any item an individual receives in cash or in-kind that can be used to meet his or her need for food or shelter.”  Items that fall into this definition can be excluded by statute.  For example, in-kind support is income, but the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) excludes it as countable income for LIS eligibility effective Jan 1, 2010.  State unemployment benefits fall into the definition of income and has not been excluded by statute, thus it is counted as income for LIS purposes.

Click here for more general information on the Part D low-income subsidy.