- Joint Statement by Center for Medicare Advocacy and Medicare Rights Center: President’s Budget Targets Key Health Care Programs
- Members of Congress Reintroduce Legislation to Fix Outpatient Observation Status
- Medicare Advantage Case Spotlight
- Spanish Language Home Health Outreach Materials Available
6th Annual National Voices of Medicare Summit &
Early-Bird Registration Ends TOMORROW
Rep. John Lewis will deliver this year’s Sen. Jay Rockefeller Lecture
Other presenters confirmed to date include Tricia Neuman, Senior Vice President, Kaiser Family Foundation; Henry Claypool, Technology Policy Consultant at AAPD and Former Director of the Health and Human Services Office on Disability; Cathy Hurwit, Former Chief of Staff for Rep. Jan Schakowsky; Ben Belton, AARP Global Partner Engagement Director; a direct-care worker from SEIU; and a special appearance by Rep. Rosa DeLauro._______________
May 9, 2019
Kaiser Family Foundation
President’s Budget Targets Key Health Care Programs
Washington, DC ─ The President’s annual budget request is a statement of values. It is incredibly troubling then, that President Trump’s budget blueprint for FY 2020, submitted this week, again prioritizes deep cuts to programs on which older adults and people with disabilities rely, including Medicare, Medicaid, and the Affordable Care Act.
The President’s FY 2020 budget includes harmful policy and payment changes that would impose barriers to care for people with Medicare. Among other things, the administration’s proposal would curtail Medicare beneficiaries’ appeal rights and increase the amount many would pay for needed prescriptions. It would also jeopardize beneficiary access to critical services by significantly cutting provider payments and greatly expanding prior authorization in traditional Medicare in a manner that could incentivize health care providers to stint on care for those with ongoing, chronic conditions.
The budget would be particularly devastating for people with Medicare who also rely on Medicaid, as it would cut the program by over $1.4 trillion in the next decade, transform it into a block grant or per-capita cap system, and end Medicaid expansion. Gutting Medicaid would lead to the rationing of care and could force many low-income seniors and people with disabilities out of their homes and into more costly institutional settings. In addition, the proposed policies would endanger Medicaid coverage for struggling families by imposing punitive coverage restrictions and administrative barriers such as work requirements and asset tests.
Further, the budget renews the administration’s efforts to repeal the Affordable Care Act and replace it with something similar to the failed 2017 Graham-Cassidy plan. That approach was widely reviled by the American people, in large part because it would have ended health coverage for millions and restricted access for millions more. Whether in the President’s budget or a stand-alone bill, any plan that would reduce coverage, weaken protections for people with pre-existing conditions, or make devastating cuts to Medicare, Medicaid, or the Affordable Care Act was, and always will be, unacceptable.
Similar to last year’s request, the President’s FY 2020 budget is full of damaging policies that would make it harder for older adults, people with disabilities, and working families to meet their basic needs. We urge Congress and the administration to reject this flawed budget, and to instead pursue bipartisan solutions that prioritize the health and well-being of all Americans.
Center for Medicare Advocacy
Medicare Rights Center
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Medicare requires a three-day inpatient hospital stay in order to qualify for care at a skilled nursing facility. Sadly, and all too often however, beneficiaries are classified as hospital outpatients on observation status. While outpatients on observation status and inpatients may receive the same care and services, for the same number of days or weeks, beneficiaries on observation status are not eligible for Medicare Part A coverage for their hospital or subsequent skilled nursing facility care. This unnecessary and arbitrary hurdle ultimately results in residents having to decide between high out-of-pocket costs or foregoing care at a skilled nursing facility.
To remedy this access barrier, Representatives Joe Courtney (D-CT), Glenn Thompson (R-PA), and Senator Sherrod Brown (D-OH) have reintroduced the Improving Access to Medicare Coverage Act of 2019 in Congress. The legislation is a bipartisan, bicameral solution that would require Medicare to count the time spent under observation status toward the three-day inpatient hospital stay requirement. As Representative Courtney notes in his press release, “three days is three days, and quibbling over semantics should not keep Americans from accessing the care they’ve been prescribed by health care professionals, or force them to go into medical debt in order to cover the cost.” Both consumer advocates and industry groups support the legislation.
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The son of a hospitalized patient recently called the Center for Medicare Advocacy. His father was ready for discharge. Physicians at both the hospital and the inpatient rehabilitation hospital (IRH) agreed that the patient would benefit from IRH services. However, the patient’s Medicare Advantage (MA) plan refused to authorize IRH care. The plan instead said it would authorize one week’s stay in a skilled nursing facility. The plan also refused to give the son a written notice from which he could appeal. All communication with the plan was oral. The son called 1-800-Medicare, and was told they could not help with issues involving a Medicare Advantage plan.
There are no good answers for this family.
The patient could disenroll from the Medicare Advantage plan and return to traditional Medicare, but disenrollment would not be effective until the first day of the following month. Further, whether a disenrolling beneficiary is eligible to purchase a Medigap plan to cover copayments and deductibles in traditional Medicare depends on the beneficiary’s state of residence. It was unlikely in this patient’s state.
The patient could file a complaint with the state insurance commissioner about the MA plan’s refusal to give him a written notice, but any resolution would not affect his immediate need for appropriate post-hospital care.
The patient could contact his Congressional representatives, but, again, any assistance they could offer would not affect his immediate need for appropriate post-hospital care.
Once again, another Medicare Advantage enrollee in need of serious care found himself stuck in a frustrating maze that did not lead to the care he needs.
 We find that high-need and dual-eligible enrollees have substantially higher disenrollment rates when compared with non–high need enrollees. This finding aligns with that of the recent Government Accountability Office report on disenrollment and other recent examples from the literature that suggest that MA plans may not currently meet the preferences of high-need enrollees. See, eg https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2725083.
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As part of the Center for Medicare Advocacy’s Medicare Outreach, Education and Advocacy Project with the Jeffrey P. Ossen Foundation, we have developed several tools for advocating for home health coverage, and now offer Spanish translations. Please feel free to download them at the links below to help in your advocacy efforts.
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The Center for Medicare Advocacy is a non-profit organization.