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NAHC Report: Issue# 2476, 7/28/2014
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
Beneficiaries Sue New York Over Loss of HCBS Services
Medicare Trustees Release their Annual Report
For Your Information: Congresswoman Gabby Giffords and Capt. Mark Kelly, Financial Expert Ric Edelman, Senate Finance Committee Chairman Ron Wyden, and Doug Rauch, Former Chairman of Trader Joe’s
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Beneficiaries Sue New York Over Loss of HCBS Services

On July 15, in Taylor v. Zucker, the New York Legal Assistance Group (NYLAG) filed a lawsuit (the Complaint) in the United States District Court for the Southern District of New York on behalf on three plaintiffs for the loss of Medicaid home care services due to the state’s transition to managed care. The Plaintiffs also sought to establish class action status. NAHC’s affiliate, the National Council on Medicaid Home Care, discusses the key elements of the lawsuit below.

The Plaintiffs sued New York for “denying, reducing and terminating Plaintiffs’ Medicaid home care services, by sending inadequate and untimely notices” as well as “failing to provide an opportunity for a fair hearing with ‘aid continuing’” “both of which threaten to result in the unnecessary institutionalization of Plaintiffs.” In New York, “Medicaid home care services” refers to home health, personal care, private duty nursing, and other types of long-term care services. Also, all Plaintiffs lacked “a change in their condition or circumstances that would justify the reduction or termination of their home care.”

Background

As mentioned in the Complaint, in New York, all Medicaid home care services shifted to managed care. Medicaid managed care first came to New York with the approval of a Section 1115 waiver in 1997, called the Partnership Plan. In 2012, CMS expanded the Partnership Plan waiver to require mandatory enrollment in Managed Long-Term Care (MLTC) plans, which are managed care plans for long-term care. This 2012 amendment required beneficiaries dually eligible for Medicare and Medicaid to enroll in MLTC plans to receive Medicaid home care services. For those just receiving Medicaid home care services, Medicaid home care services was included in managed care via mainstream Medicaid managed care plans (MMCs) beginning August 2011.

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Medicare Trustees Release their Annual Report
Report projects that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report

The Medicare Trustees recently released their Annual Report that found that trust fund that finances Medicare’s Part A coverage will remain solvent until 2030, four years beyond what was projected in last year’s report. Part A covers hospital insurance, along with hospice and a portion of the home health benefit. The Trustees cite several factors for the improved outlook – including recent cost controls that have been implemented – that has reduced per capita Medicare spending. Medicare spending, the Trustees found, will continue to grow at a slower rate than the overall economy over the next several years.

It is believed that the additional years of solvency for the Medicare Trust fund will take some of the immediate pressure off of recent calls to overhaul or cut the program in order to extend its solvency, however there are still vocal calls to change the traditional Medicare system entirely – such as turning it into one of vouchers.

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Congresswoman Gabby Giffords and Capt. Mark Kelly, Financial Expert Ric Edelman, Senate Finance Committee Chairman Ron Wyden, and Doug Rauch, Former Chairman of Trader Joe’s
Appearing at NAHC’s Annual Meeting, October 19 – 22 in Phoenix, AZ

Registration is now open for NAHC’s Annual Meeting & Exposition, held this year in Phoenix, AX October 19 – 22. This year’s Annual Meeting & Exposition includes nationally and internationally renowned keynote speakers such as former Congresswoman Gabby Giffords and Capt. Mark Kelly, financial expert Ric Edelman, and Senate Finance Committee Chairman Ron Wyden.

This year’s Annual Meeting will also offer track-specific educational sessions, informative round table discussions and much, much more.

For more on this year’s General Session speakers, please click here.

To register to attend this year’s Annual Meeting & Exposition, please click here.

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