CHA Blog

• 16Jun

  One Away Video Campaign Uses Vulnerable Seniors’ Stories to Advocate for Change

  Low-income help No Comments

  Do you know of any senior citizens who are in challenging times? Anyone who is struggling to make their rent, food and/or health care payments? Let their stories be heard! One Away is an innovative, national video advocacy campaign that gives voice to vulnerable older adults who are struggling to make ends meet in today’s economy. The campaign captures their real stories on video—and calls for legislative and policy changes to make it easier for these elders to get the services and supports they need to live with independence and dignity. The National Council on Aging (NCOA) is working with Local Advocacy Partners nationwide on this campaign. Here’s info and videos of Californians telling their tales.

  For more info, see the One Away website.

• 02Jun

  Part D “Chooser” Letter Sent Out to Close to 1 Million LIS Beneficiaries

  Low-income help No Comments

  If you work with beneficiaries with the Part D Low-Income Subsidy (LIS), the Centers for Medicare and Medicaid Services (CMS) sent out the spring “Chooser Reminder” notices (pdf) this week to about 944,000 LIS beneficiaries around the country. These are beneficiaries who are currently enrolled in a drug plan whose premium is not fully covered by the LIS. It reminds them that they can switch to a plan that is fully covered and therefore has $0 premium at any time.

  For a list of 2011 plans with $0 premiums for people with the LIS (also referred to as “benchmark plans”), see our section “Benchmark Prescription Drug Plans.”

  For more information on Medicare Part D, see our Prescription Drugs section.

   

• 23May

  Certain Seniors & People with Disabilities Required to Enroll into Medi-Cal Managed Care Plans

  Low-income help No Comments

  Starting June 2011, California’s Department of Health Care Services (DHCS) is requiring people with disabilities and seniors who have Medi-Cal only (not Medicare) to enroll in a Medi-Cal managed care plan.  DHCS has worked with the California HealthCare Foundation and the Center for Health Care Strategies to coordinate a 90-minute informational webinar to provide information about the upcoming change to advocates and organizations that serve seniors and people with disabilities.  Three sessions have already been held and 2 more will be held on Wed. May 25th. One session is from 10 – 11:30 a.m. and the other is from 12:30 -2 p.m.

  Sign up as space is limited. Register for the Medi-Cal Informational Webinar online.

  This change will affect the following 16 California counties: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, Stanislaus and Tulare.

  More info on this change will be posted soon.

• 19May

  Reviewing LI NET Part D Coverage & the Best Available Evidence Policy

  Low-income help, Prescription drugs No Comments

  It’s been a while since we’ve talked about the Limited Income Newly Eligible Transition (LI NET) program for Part D coverage and the Best Available Evidence (BAE) policy, and sometimes people get these confused.

  To clarify, LI NET is a  ”safety net” Part D prescription drug coverage for low-income subsidy (LIS) eligible beneficiaries who are NOT currently enrolled in a Part D plan. The Best Available Evidence policy, however, is for people who ARE enrolled in a Part D plan, and is used when a person’s plan does not know s/he is LIS eligible. In these situations, instead of putting the burden of providing “official” proof of LIS eligibility on the beneficiary, the BAE policy allows for the beneficiary to show minimal evidence and therefore receive their prescriptions at the lower subsidized cost.

  For more information on LI NET, see the Centers for Mediare and Medicaid Services’ (CMS) recent LI NET update (PDF).

  For more information on the Best Available Evidence policy, see our BAE article.

• 20Apr

  State Stops Paying Medicare Part B Premiums for Beneficiaries with Any Share of Cost Medi-Cal

  Low-income help No Comments

  Medi-Cal is no longer paying the Medicare Part B premium for any Medicare beneficiaries who have Medi-Cal with a Share of Cost (SOC), unless they meet their SOC in a given month. The change is the result of a budget trailer bill (Senate Bill 853) amending Welfare and Institutions (W&I) Code 14005.11, and is estimated to affect about 700 beneficiaries throughout California. It expands the policy change made in November 2008 when the state stopped paying the Part B premium for people with SOCs over $500. The recent change took effect April 1, 2011; for those affected, the Part B premium will be deducted from their Social Security checks beginning in May 2011.

  If you are affected by this change and now have to pay the Medicare Part B premium, make sure your county Medi-Cal office screens you for other programs that pay the Medicare Part B premium. County Medi-Cal offices are required to screen all affected beneficiaries for programs such as the Medicare Savings Programs (MSPs) – Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI-1) – which pay the Medicare Part B premium as a benefit.  Beneficiaries who currently have one of these 3 MSPs continue to have their Medicare Part B premiums paid, regardless of whether they also have Medi-Cal with a SOC.

  If your income is too high to qualify for any of the MSPs, you may consider the California Working Disabled (CWD) program. The CWD program allows people with disabilities the opportunity to work, earn income up to 250% of the federal poverty limit (FPL) and still qualify for full Medi-Cal without a SOC. People who qualify for the CWD program pay a monthly premium for their full Medi-Cal benefits ranging from $20-$250 for an individual and $30-$375 for a couple. For most people who qualify for the CWD program, paying the monthly premium every month and getting full Medi-Cal benefits is better than having to meet their SOC every month before getting assistance from Medi-Cal. See our section on Medicare Savings Programs for more info on the MSPs and the 250% California Working Disabled program.

  See the 6-page All County Welfare Department Letter (ACWDL no. 11-15) (PDF) for details about this change.

• 13Dec

  Physicians Payment Cut Averted & QI Program & Therapy Exceptions Process Extended

  Low-income help, Medicare basics No Comments

  The House has passed the Medicare and Medicaid Extenders Act of 2010 (by a vote of 409-2), a day after it was unanimously passed by the Senate.  The “doc fix” provision has gotten the most media coverage, though the bill also extends other items that are slated to expire Dec 31, 2010.  President Obama signed this legislation on Dec 15, 2010.

  Below is a brief summary of 3 Medicare-related provisions:

  1.     The physician payment cut of 25%, scheduled to be effective Jan 1, 2011, is blocked, and the current payment rate is extended until Dec 31, 2011.  Congress is expected to come up with a long term solution to the sustainable growth rate.  Note: they are offsetting this expenses by asking for a repayment from some who would get a subsidy to buy health care insurance.  To read more, here is an article from the California Healthline.  Two California House reps are quoted in that article: Tom McClintock, who voted against the bill, and Wally Herger.

  2.     The Qualified Individual (QI) program is extended until Dec 31, 2011.  Advocates have been asking that this Medicare Savings Program (MSP) be made permanent, like QMB and SLMB, but that won’t be accomplished with this bill.

  3.     The exceptions process to the Medicare Part B outpatient therapy caps is extended until Dec 31, 2011.  Beneficiaries who are likely to exceed the therapy caps for physical therapy and speech therapy combined or occupational therapy can continue to get an exception.

  See the text of the Medicare and Medicaid Extenders Act of 2010 for more information.

• 14Sep

  Medi-Cal Re-instates Optometry Services

  Low-income help 5 Comments

  Due to California’s budget cuts, several of Medi-Cal’s optional benefits, including optometry services for adult Medi-Cal beneficiaries were excluded from Medi-Cal coverage as of July 1, 2009.

  This summer, however, the Department of Health Care Services (DHCS) reinstated optometry services for adult Medi-Cal beneficiaries. (21 years old and over), effective July 26, 2010.

  Now, Medi-Cal once again covers the following optometry services:

  • Eye exams and office visits
  • Refraction test used to determine the eyeglass prescription
  • Eye tests used to evaluate the health of the eyes when medically indicated
  • Low vision evaluation for the visually impaired
  • Contact lens evaluation for those with certain eye diseases

  Medi-Cal does not cover:

  • Eyeglasses, including repair and replacement
  • Contact lenses
  • Low vision aids

  Exceptions
  Medi-Cal does cover both optometry services and eyeglasses and other eye appliances for a few limited categories of beneficiaries. These include:

  • Pregnant women and only if medically necessary to prevent harm to the pregnancy
  • Children or young adults who are under 21 years old with full-scope Medi-Cal
  • Residents of a licensed Skilled Nursing Facility or Intermediate Care Facility, including ICF-Developmentally Disabled, ICF-Habilitative and ICF-Nursing.

  Opportunity for Reimbursement for Out-of-Pocket Expenses
  As part of the optometry reinstatement, DHCS will reimburse eligible adult Medi-Cal beneficiaries for out-of-pocket expenses up to the Medi-Cal rate paid for covered optometry services incurred while the optometry services were eliminated (basically expenses between July 1, 2009 – July 25, 2010).

  Eligible beneficiaries must request reimbursement from DHCS on or before February 1, 2011.

  To request reimbursement, Medi-Cal beneficiaries can call or write to:

  California Department of Health Care Services
  Beneficiary Service Center
  P.O. Box 138008
  Sacramento, CA 95813-8008
  (916) 403-2007
  TDD: (916) 635-6491

  More information can also be obtained on the DHCS website.

  Medi-Cal beneficiaries may also contact their Medi-Cal caseworker for information on how to request a reinstatement for out-of-pocket expenses.

  See our Medi-Cal section for more general information on the Medi-Cal program.

  Tags: coverage, eye glasses, Medi-Cal, optometry

• 01Jul

  Obama Holds Tele-Town Hall Meeting to Discuss Health Reform with Seniors

  Health Care Reform, Low-income help, Medicare Advantage, Medicare and other health insurance, Medicare basics, Prescription drugs No Comments

  Early last month, President Obama hosted a ‘tele’-town hall meeting for Medicare beneficiaries about the Affordable Care Act and Medicare fraud prevention efforts in light of the first $250 donut hole rebate checks that were sent out mid June. This meeting can be viewed online at whitehouse.gov.

  In this video, President Obama discusses the following topics:

  (Note: By clicking on a linked question, it will take you directly to that section of the video.)

  • Why does it take 10 years to close the doughnut hole completely?
  • Will Medicare Advantage changes hurt benefits?
  • Is there more support for primary care?
  • How does reform affect living independently vs in a nursing home?
  • Are Medicare & Social Security going to run out of money for future generations?
  • What’s going to happen to COBRA subsidies?

  For more information on health care reform and Medicare, see our article, What Does Health Reform Mean for Medicare Beneficiaries? Summary of Key Provisions.

• 24May

  Are You Eligible for the Part D $250 Rebate? CMS Posts Q&As

  Health Care Reform, Low-income help, Medicare basics 2 Comments

  The Affordable Care Act passed by Congress and signed by President Obama this year contains some important benefits for Medicare recipients. One benefit is the $250 rebate to help with beneficiaries’ Medicare Part D drug costs. Beneficiaries who do not receive the low-income subsidy (LIS), will automatically receive this one-time $250 rebate check from Medicare after they reach the coverage gap (also called the “donut hole”) in 2010. This rebate is the first step toward closing the Medicare prescription drug coverage gap as mandated in the new health care reform law.

  Below are a few common questions and answers on this $250 rebate that the Centers for Medicare and Medicaid Services (CMS) sent out last week. Please share it with your colleagues and beneficiary clients.

  What is the coverage gap and how will I know if I’ve reached it?

  Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit).

  The Explanation of Benefits notice, which your drug plan mails to you each month when you fill a prescription, will tell you how much you’ve spent on covered drugs and whether you’ve entered the coverage gap.

  Will I need to do anything to get this rebate check?

  No. There are no forms to fill out. Medicare will automatically send a check that’s made out to you. You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check. Don’t give your personal information to anyone who calls you about the $250 rebate check. Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

  When will I get the rebate check?

  If you reach the coverage gap this year and enter the Part D “donut hole”, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help.  These checks will begin to get mailed to beneficiaries starting in mid-June.

  Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap. However, this is a one-time benefit and beneficiaries who qualify will only receive one check after they reach the coverage gap.

  What if I don’t get the rebate check when I should?

  Beneficiaries who hit the donut hole after the program has begun should expect to receive their check within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should call your Medicare drug plan to make sure all of your information has been sent to Medicare.

  If you don’t get your rebate check, contact Medicare. Individuals receiving Medicare Extra Help will not receive a rebate check.

  You can also check to make sure Social Security has your correct home address. Call 1-800-772-1213 or your local Social Security office. TTY users should call 1-800-325-0778.

  What’s Next ….Coming in 2011

  If you reach the coverage gap in 2011, you may get a 50% discount on your brand name prescription drugs at the time you buy them. Stay tuned for more information from Medicare.

  Help  stop scams against beneficiaries
  

  Remember- there are no forms to fill out to receive this benefit once someone qualifies for it. Medicare will automatically send a check that’s made out to the qualified beneficiary.

  Beneficiaries also don’t need to provide any personal information like their Medicare, Social Security, or bank account numbers to get the rebate check. Please remind them to NOT give their personal information to anyone who calls them about the $250 rebate check. They should call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

  Go to stopmedicarefraud.gov to learn more about how Medicare is working with law enforcement to stop scams against seniors.

  More questions about the $250 rebate check or the Affordable Care Act and Medicare?

  Beneficiaries with more questions can refer to the brochure Medicare and the New Health Care Law–What it Means for You (PDF) that Medicare sent them. (Also available in Spanish (PDF)). They can also visit www.medicare.gov, call 1-800-MEDICARE, or visit www.healthreform.gov.

• 12May

  How Do Denti-Cal Cuts Affect Our 8 Million Low-Income, Elderly & Disabled People?

  Low-income help No Comments

  Denti-Cal, Medi-Cal’s fee-for-service (FFS) dental program, was the primary source and payer of dental care for more than 8 million low-income, elderly, and disabled people in California in 2007. In 2009, most of the Medi-Cal adult dental benefits were eliminated due to the state’s budget deficit. Children’s services, as required by federal law, continue to be delivered.

  The California HealthCare Foundation (CHCF) recently published an almanac on Denti-Cal which covers the organization of Medi-Cal’s fee-for-service dental program in 2007, how it was funded, and the demographics of the population it served. It identifies the challenges the program faces in continuing to make dental care available to children, and the potential consequences of leaving a large segment of the adult Medi-Cal population with no care at all.

  See: Denti-Cal Facts and Figures (pdf)

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