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Monthly Archives: December 2018

CMS Issues Guidance to Help States Better Serve People with Medicare and Medicaid

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a Dear State Medicaid Director letter highlighting ten opportunities for states to better serve individuals dually eligible for Medicare and Medicaid.

Medicaid is an important source of coverage for nearly 12 million people with Medicare. It covers needed services that Medicare does not, such as long-term care. Medicaid also helps make Medicare more affordable by helping pay Medicare premiums and/or cost-sharing, which can be high for people with low incomes.

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Texas Affordable Care Act Decision Flawed; ACA is Still the Law of the Land

In a radical departure from established legal doctrine, a federal judge in Texas issued a ruling against the Affordable Care Act (ACA) on December 14, claiming that the entire law must fall. At the center of the lawsuit, brought by a coalition of Republican-led states, was the ACA’s individual mandate and penalty for failure to be insured. Congress repealed this penalty in last year’s tax bill. As a result, the lawsuit claimed the ACA was invalid. Unfortunately, the district court in Texas agreed with this flawed analysis, although legal scholars have denounced it across the ideological spectrum.

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Congress Close to Finalizing Important Medicaid Extensions

On Tuesday, the U.S. House of Representatives passed the IMPROVE Act (H.R. 7217), which extends two critical Medicaid programs for older adults and people with disabilities. The U.S. Senate is expected to approve the bill before adjourning for the year.

First authorized in the Deficit Reduction Act of 2005, the Medicaid Money Follows the Person Demonstration Program (MFP) officially launched in 2007. Since then, it has helped over 88,000 older adults and people with disabilities transition from nursing and other facilities back to the community, and it has consistently been a cost-effective, successful program. According to independent, national evaluations MFP participants who have transitioned to community-based settings experience lasting improvements in quality of life, and they also decrease their overall Medicare and Medicaid expenditures by roughly 23%, generating considerable cost savings for the programs.

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Leveling the Medigap Playing Field

At the Medicare Rights Center, we encourage states to provide equal protections for people with Medicare, regardless of age. Last week, we joined the American Kidney Fund to explain the importance of Medigap access for people under 65 to the National Conference of State Legislatures.

Most people with Medicare have two major options when choosing how to receive their Medicare coverage: Original Medicare or Medicare Advantage. While this decision is complicated, those who choose Original Medicare may have another decision to make as well—whether to add Medigap coverage.

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Medicare Advantage Directories Remain Full of Errors Due to CMS Inaction

It is important that Medicare Advantage organizations (MAOs) supply complete, accurate, and easily accessed provider directories to ensure those who enroll in Medicare Advantage (MA) plans know which providers are in a given plan’s network. Unfortunately, as we have highlighted before, MAO provider directories are not complete and accurate. Instead, for the third year running, the Centers for Medicare & Medicaid Services (CMS), the agency that runs the Medicare program, has revealed directory audit results showing widespread errors and inaccuracies.

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CMS Proposes Changes to Protected-Class Drugs

Last week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would allow Part D and Medicare Advantage plans to use additional tools to reduce prescription drug prices. Some of these tools rely on weakening the protections for consumers who take certain medications in what are known as the “protected classes.”

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