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Public Benefit Forum Posts
Public Benefit Legal Resources
Obamacare Exchanges Are Doing OK Despite Withdrawls of Some Insurance Companies
The high profile withdrawals of a few national insurers from Obamacare exchanges have some experts wondering whether the exchanges are entering a death spiral. The companies’ reports of large losses have led to speculation that the exchanges are unsustainable... Despite the losses suffered by some insurance companies, many others are turning a profit according to a recent report by the consulting firm McKinsey & Company.
The Office of Administrative Hearings now has a searchable database of selected decisions.
The Office of Administrative Hearings has launched a searchable portal of select decisions dating back to last September to assist attorneys and members of the public with researching administrative law cases.
http://decisions-oah.maryland.gov/Pages/Search-Hearings.aspx
SSA expands online wage reporting through mySocial Security to SSI recipients and their rep payees.
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I am pleased to announce that we are expanding our my Social Security online wage reporting service to Supplemental Security Income (SSI) recipients, as well as their spouses, parents, sponsors, and representative payees. Individuals receiving both Social Security Disability Insurance (SSDI) and SSI, as well as their representative payees, can also report wages online. This service is available through our existing my Social Security portal. Check our website to learn more about my Social Security features and how to sign up. Note: SSI recipients, their spouses, parents, sponsors,
and representative payees may still use the SSI Mobile Wage Reporting and SSI
Telephone Wage Reporting applications. However, the preferred wage reporting
method for individuals receiving both SSDI and SSI is the my Social Security online
wage reporting service. Sincerely, Matthew Baxter
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Maryland Medicaid to cover cochlear implants & hearing aids for adults
From Diasabilty Rights Maryland:
Subject: [NHeLP Confidential] Maryland Medicaid to cover cochlear implants & hearing aids for adults
I’m thrilled to share that effective July 1, Maryland Medicaid will be covering hearing aids and cochlear implants for adults, which until now were only provided under EPSDT.
1. Coverage policy and impact on other states
The CMS-approved SPA includes extensive information about the coverage policy. Hearing aids will be covered as medical equipment, and cochlear implants as prosthetics.
Disability Rights Maryland (DRM)’s position is that both hearing aids and cochlear implants qualify as “medical equipment” under CMS’s 2016 Home Health Rule (available here; FAQ on the Rule by the National Assistive Technology Advocacy Project is here) and therefore are included in the mandatory home health services benefit. Cochlear implants are classified as prosthetics under Medicare, so it makes some sense that CMS approved them in that category here as well; however, the Home Health Rule also states that if an item could be placed in two categories, including home health, it must still be covered under the home health benefit. This matters because while prosthetics are an optional category, home health is mandatory.
Because CMS approved coverage of hearing aids as medical equipment, they are subject to the mandatory Home Health Rule that is applicable to all states. In other words, this SPA should help advocates in other states argue for adult coverage of hearing aids as well.
2. Proposed regulations
Maryland’s proposed regulations to implement this change are available at http://www.dsd.state.md.us/MDR/4513.pdf (starting at p.671; they amend COMAR 10.09.51, available here). They were issued on June 22 and are subject to a 30-day public comment period through July 23 (which is admittedly after coverage will have already begun). If anyone has thoughts or questions about the regulations, I’d certainly appreciate your input as we’re drafting our comments. Happy to discuss by phone as well.
3. HUGE thanks & follow-up discussions
DRM has worked on this project with a team of DC-based Sidley Austin attorneys since 2013. Thanks so much to NHeLP and several others on this list who’ve provided invaluable guidance and brainstorming several times since then.
If folks have questions about how this came about or would like to discuss our arguments for covering hearing aids and/or cochlear implants under the Home Health Rule, please let me know.
Further information:
Maryland Medicaid provider transmittal: https://mmcp.health.maryland.gov/MCOupdates/Documents/pt_31-18.pdf (noting the Provider Manual online will be updated by 7/1/18)
Sarah Steege
Attorney
Disability
Rights Maryland, formerly Maryland Disability Law Center
1500 Union Ave., Suite 2000
Baltimore, MD 21211
Tel 443-692-2497
Fax
410-727-6389
SarahS@DisabilityRightsMD.org
Visit our new website at www.DisabilityRightsMD.org
Maryland Medicaid to cover cochlear implants & hearing aids for adults
From Diasabilty Rights Maryland:
Subject: [NHeLP Confidential] Maryland Medicaid to cover cochlear implants & hearing aids for adults
I’m thrilled to share that effective July 1, Maryland Medicaid will be covering hearing aids and cochlear implants for adults, which until now were only provided under EPSDT.
1. Coverage policy and impact on other states
The CMS-approved SPA includes extensive information about the coverage policy. Hearing aids will be covered as medical equipment, and cochlear implants as prosthetics.
Disability Rights Maryland (DRM)’s position is that both hearing aids and cochlear implants qualify as “medical equipment” under CMS’s 2016 Home Health Rule (available here; FAQ on the Rule by the National Assistive Technology Advocacy Project is here) and therefore are included in the mandatory home health services benefit. Cochlear implants are classified as prosthetics under Medicare, so it makes some sense that CMS approved them in that category here as well; however, the Home Health Rule also states that if an item could be placed in two categories, including home health, it must still be covered under the home health benefit. This matters because while prosthetics are an optional category, home health is mandatory.
Because CMS approved coverage of hearing aids as medical equipment, they are subject to the mandatory Home Health Rule that is applicable to all states. In other words, this SPA should help advocates in other states argue for adult coverage of hearing aids as well.
2. Proposed regulations
Maryland’s proposed regulations to implement this change are available at http://www.dsd.state.md.us/MDR/4513.pdf (starting at p.671; they amend COMAR 10.09.51, available here). They were issued on June 22 and are subject to a 30-day public comment period through July 23 (which is admittedly after coverage will have already begun). If anyone has thoughts or questions about the regulations, I’d certainly appreciate your input as we’re drafting our comments. Happy to discuss by phone as well.
3. HUGE thanks & follow-up discussions
DRM has worked on this project with a team of DC-based Sidley Austin attorneys since 2013. Thanks so much to NHeLP and several others on this list who’ve provided invaluable guidance and brainstorming several times since then.
If folks have questions about how this came about or would like to discuss our arguments for covering hearing aids and/or cochlear implants under the Home Health Rule, please let me know.
Further information:
Maryland Medicaid provider transmittal: https://mmcp.health.maryland.gov/MCOupdates/Documents/pt_31-18.pdf (noting the Provider Manual online will be updated by 7/1/18)
Sarah Steege
Attorney
Disability
Rights Maryland, formerly Maryland Disability Law Center
1500 Union Ave., Suite 2000
Baltimore, MD 21211
Tel 443-692-2497
Fax
410-727-6389
SarahS@DisabilityRightsMD.org
Visit our new website at www.DisabilityRightsMD.org
Maryland Medicaid to cover cochlear implants & hearing aids for adults
From Diasabilty Rights Maryland:
Subject: [NHeLP Confidential] Maryland Medicaid to cover cochlear implants & hearing aids for adults
I’m thrilled to share that effective July 1, Maryland Medicaid will be covering hearing aids and cochlear implants for adults, which until now were only provided under EPSDT.
1. Coverage policy and impact on other states
The CMS-approved SPA includes extensive information about the coverage policy. Hearing aids will be covered as medical equipment, and cochlear implants as prosthetics.
Disability Rights Maryland (DRM)’s position is that both hearing aids and cochlear implants qualify as “medical equipment” under CMS’s 2016 Home Health Rule (available here; FAQ on the Rule by the National Assistive Technology Advocacy Project is here) and therefore are included in the mandatory home health services benefit. Cochlear implants are classified as prosthetics under Medicare, so it makes some sense that CMS approved them in that category here as well; however, the Home Health Rule also states that if an item could be placed in two categories, including home health, it must still be covered under the home health benefit. This matters because while prosthetics are an optional category, home health is mandatory.
Because CMS approved coverage of hearing aids as medical equipment, they are subject to the mandatory Home Health Rule that is applicable to all states. In other words, this SPA should help advocates in other states argue for adult coverage of hearing aids as well.
2. Proposed regulations
Maryland’s proposed regulations to implement this change are available at http://www.dsd.state.md.us/MDR/4513.pdf (starting at p.671; they amend COMAR 10.09.51, available here). They were issued on June 22 and are subject to a 30-day public comment period through July 23 (which is admittedly after coverage will have already begun). If anyone has thoughts or questions about the regulations, I’d certainly appreciate your input as we’re drafting our comments. Happy to discuss by phone as well.
3. HUGE thanks & follow-up discussions
DRM has worked on this project with a team of DC-based Sidley Austin attorneys since 2013. Thanks so much to NHeLP and several others on this list who’ve provided invaluable guidance and brainstorming several times since then.
If folks have questions about how this came about or would like to discuss our arguments for covering hearing aids and/or cochlear implants under the Home Health Rule, please let me know.
Further information:
Maryland Medicaid provider transmittal: https://mmcp.health.maryland.gov/MCOupdates/Documents/pt_31-18.pdf (noting the Provider Manual online will be updated by 7/1/18)
Sarah Steege
Attorney
Disability
Rights Maryland, formerly Maryland Disability Law Center
1500 Union Ave., Suite 2000
Baltimore, MD 21211
Tel 443-692-2497
Fax
410-727-6389
SarahS@DisabilityRightsMD.org
Visit our new website at www.DisabilityRightsMD.org
Updated chart for special enrollment periods under the ACA
The Center on Budget and Policy Priorities has published an updated chart on the events that trigger a special enrollment period under the Affordable Care Act. Normally one can only enroll in a health plan through the exchange during a now limited open enrollment period. However certain events can permit one to enroll at any time. The chart sets out information about these "special enrollment periods."
http://www.healthreformbeyondthebasics.org/wp-content/uploads/2015/06/SEP-Reference-Chart.pdf
Trustees Report on the Social Security Trust Funds
On June 5, 2018 the Social Security Board of Trustees released its annual report on the long-term financial status of the Social Security Trust Funds. Social Security is NOT going bankrupt.
The OASI Trust Fund (retirement and survivors’ benefits) is projected to become depleted in late 2034, as compared to last year’s estimate of early 2035, with 77 percent of benefits payable at that time. The DI Trust Fund (disability benefits) will become depleted in 2032, extended from last year’s estimate of 2028, with 96 percent of benefits still payable.
With no action from Congress, Social Security can continue to provide 100% of the retirement benefits people are owed until 2034. After that, even if absolutely no changes were made, beneficiaries would still receive 77% of their benefits. People receiving disability benefits will get their full benefit check until 2032 and, if Congress makes no changes, they will receive 96% of their benefits thereafter.
You can read the entire report by clicking here.
The Baltimore Social Security office at the Rotunda will close June 22, 2018.
Social Security is closing many local offices nationwide, perhaps as many as 125 since 2000. This makes it more difficult for the elderly and people with disablities to access services and get information.
Read more at: http://www.baltimoresun.com/news/maryland/baltimore-city/bs-md-ci-social-security-office-closing-20180516-story.html
Information on Medicare Savings Programs (QMB & SLMB) as of March 2018
Information on income and resource eligibility for the Medicare Savings Programs (QMB & SLMB) and what those programs cover.
How Medicaid Work Requirements Will Harm Older Adults & Family Caregivers
Justice in Aging explains how work requirements and onerous reporting obligations create barriers to health care access for many older adults, people with disabilities and serious health conditions, and family caregivers who rely on Medicaid.
http://www.justiceinaging.org/wp-content/uploads/2018/04/How-Medicaid-Work-Requirements-Will-Harm-Older-Adults-Family-Caregivers.pdf?eType=EmailBlastContent&eId=1dd68041-dfb6-4dc3-9bf5-48b7d85d7599
A new law will bring added oversight to Social Security's representative payee program. (From Disability Scoop)
Trump Signs Bill Adding Protections For Social Security, SSI Recipients
by Shaun Heasley | April 17, 2018
Individuals tasked with handling Social Security payments for people with disabilities will be subject to greater scrutiny under a new law signed by President Donald Trump.
The president signed the measure known as the Strengthening Protections for Social Security Beneficiaries Act of 2018, or H.R. 4547, late last week after it was unanimously approved by Congress.
The legislation will impose greater oversight on representative payees who manage Social Security and Supplemental Security Income benefits for those who need assistance.
Specifically, the law bars people with certain types of criminal convictions from acting as representative payees and prevents individuals who have representative payees themselves from serving in that capacity for others. And, it will give beneficiaries more say in who handles money on their behalf by allowing Social Security recipients to make a list of their preferred payees in order of preference.
Meanwhile, the legislation will require that protection and advocacy groups in each state — federally-mandated organizations that provide legal assistance and advocate for people with disabilities — conduct more reviews of representative payee performance on behalf of the Social Security Administration.
In addition to enhancing oversight, the measure will also eliminate a requirement that parents or spouses living with a person with a disability complete an annual accounting form for representative payees.
“This new law is great news for the millions of Social Security beneficiaries who rely on a representative payee to help them manage their benefits,” said U.S. Rep. Sam Johnson, R-Texas, who sponsored the legislation. “Not only will it provide much-needed accountability for the representative payee program, but it also puts measures into place that ensure newly selected representative payees are qualified and trustworthy.”
According to the Social Security Administration’s Office of the Inspector General, some 6.2 million individuals or organizations act as representative payees on behalf of about 8 million beneficiaries. Such representatives are assigned if the agency determines that a person’s mental or physical condition prevents them from being able to manage their benefits.
Proponents of the legislation cited concerns from the Government Accountability Office, the Social Security Administration’s Office of the Inspector General, the National Academy of Sciences and the Social Security Advisory Board about how Social Security officials have administered the representative payee program.
“For too long dishonest representative payees have exploited and abused people with disabilities without fear of being discovered,” said Curt Decker, executive director of the National Disability Rights Network, an umbrella group for the nation’s protection and advocacy organizations. “That stops today. We are thrilled to see that Congress has acted to protect the more than 8 million Americans who currently have representative payees.”
Elder Law articles
The MSBA Bar Bulletin, April 15, 2018, has a lot of good substantive articles on elder law topics - Adv Directives and MOLST, Guardianship changes, Social Security Disability changes, ABLE, new Medicare cards and MA-LTC rules about protecting the home under the Parental Care Rule.
New Budget Increases Some Programs for the Elderly
From Justice in Aging:
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New Budget Increases Some Programs for the Elderly
From Justice in Aging:
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SSA's Data on Hearing Delays at Office of Hearings Operations (formerly ODAR) Locations
The Soc. Sec. Admin. releases data the average time (in months) from the date of the hearing request until a hearing was held for cases closed in the Office of Hearings Operations' hearing offices or national hearing centers.
Baltimore City 17 months
Natiional Hearing Cntr, Balt. 17.5 months
Dover, DE 17 months
Morgantown, WV 21 months
Washington 20 months
Social Security and SSI benefits to increase by 2% in 2018
The Social Security Administration has announced that based on the increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of 2016 through the third quarter of 2017, monthly Social Security and Supplemental Security Income (SSI) benefits will increase 2.0 percent in 2018.
The 2.0 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 61 million Social Security beneficiaries in January 2018. Increased payments to more than 8 million SSI beneficiaries will begin on December 29, 2017.
The monthly SSI Federal Payment Standard will increase to $750 for an individual and to $1125 for a couple.
The Substantial Gainful Activity (SGA) monthly threshold will be $1180. The Trial Work Period (TWP) monthly threshold will be $850.
One will need to earn $1320 in 2018 to receive credit for a quarter of coverage.
Here is a link to a fact sheet that contains more facts and figures for Social Security benefits in 2018: https://www.ssa.gov/news/press/factsheets/colafacts2018.pdf
Social Security and SSI benefits to increase by 2% in 2018
The Social Security Administration has announced that based on the increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of 2016 through the third quarter of 2017, monthly Social Security and Supplemental Security Income (SSI) benefits will increase 2.0 percent in 2018.
The 2.0 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 61 million Social Security beneficiaries in January 2018. Increased payments to more than 8 million SSI beneficiaries will begin on December 29, 2017.
The monthly SSI Federal Payment Standard will increase to $750 for an individual and to $1125 for a couple.
The Substantial Gainful Activity (SGA) monthly threshold will be $1180. The Trial Work Period (TWP) monthly threshold will be $850.
One will need to earn $1320 in 2018 to receive credit for a quarter of coverage.
Here is a link to a fact sheet that contains more facts and figures for Social Security benefits in 2018: https://www.ssa.gov/news/press/factsheets/colafacts2018.pdf
2017 Welfare Advocates Conference
The 2017 Welfare Advocates Conference is coming up on November 2 at the Radisson Hotel in Timonium, MD. This year, we are excited that our keynote speaker will be Marc Steiner, and he'll be talking about how to amplify the stories and voices of individuals who are marginalized. We are also having an interactive closing plenary where local leaders –including the CEOs of United Way, Catholic Charities, Advocates for Children and Youth, and the Jobs Opportunity Task Force - are being pitched the question "How Do We End Poverty?" that they’ll each answer from their own perspectives. Our theme this year is Casting a Wide Net, speaking to the need for inclusivity in our organizations, in our communities, and in our policies. Along that theme, we are having workshops on assisting our immigrant neighbors, working with LGBTQ youth, and violence prevention efforts in West Baltimore, among others. Our 1-day conference also offers 5 Category 1 CEUs for social workers! Need more convincing? On top of a delicious Italian lunch, we have incredible door prizes this year including (for the first time) tickets to the National Aquarium, tickets to see Madam Butterfly, two different ski packages at two different resorts, and several area restaurant gift cards!
For more information - and to register - please follow this link: http://events.r20.constantcontact.com/register/event?oeidk=a07eemdqtmk39.... It's really a great conference and we hope to see you there!
Social Security Adds Three Health Conditions to the Compassionate Allowance List.
The Social Security Administration has added three new Compassionate Allowances conditions:
CACH--Vanishing White Matter Disease-Infantile and Childhood Onset Forms
Congenital Myotonic Dystrophy, and
Kleefstra Syndrome
Compassionate Allowances are a way to quickly identify serious diseases and other medical conditions that meet Social Security's standards for disability benefits.
The Compassionate Allowances program identifies claims where the applicant’s disease or condition clearly meets Social Security’s statutory standard for disability. Many of these claims are allowed based on medical confirmation of the diagnosis alone, for example pancreatic cancer, amyotrophic lateral sclerosis (ALS), and acute leukemia.
For more information about the program, including a list of all Compassionate Allowances conditions, please click here
or go to https://www.ssa.gov/compassionateallowances/conditions.htm.
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