Medicare Rights NY:r Issue 20

Medicare Rights Advocacy

Governor Cuomo releases New York State budget 

The 2021 NYS Executive Budget includes several provisions affecting dually eligible individuals, long-term care, and integrated care. The enacted changes affect Dual-eligible Special Needs Plans (D-SNPs), Managed Long-Term Care (MLTC) plans, and various Medicaid services. However, the effective dates for some of these changes remains unclear.

One enacted change requires that dually eligible individuals who are enrolled in D-SNPs but do not require long-term care must enroll in an available affiliated Medicaid plan. This requirement may mean increased statewide enrollment in Medicaid Advantage plans, as well as a greater number of Medicaid Advantage plan offerings. Medicaid Advantage plans combine a D-SNP and a Medicaid managed care (MMC) plan and are designed to provide more integrated care. 

Effective March 1, 2020, through March 31, 2022, the state has placed a moratorium on processing and approving applications from insurers to operate MLTC plans. This moratorium includes applications from insurers that currently offer MLTC plans and want  to expand their service area or scope of eligible population. Individuals enrolled or interested in enrolling in an MLTC plan will still have access to currently available plan options during the moratorium, but there will be no new plans. 

Integrated appeals implemented in Medicaid Advantage Plus

The integrated grievance and appeals demonstration for Medicaid Advantage Plus (MAP) plans began January 1, 2020. The Centers for Medicare & Medicaid Services (CMS) and New York State Department of Health (NYSDOH) entered a memorandum of understanding (MOU) for the demonstration, which will run through 2023. The MOU and other materials related to this demonstration are posted on the CMS New York Financial Alignment Initiative webpage. There are eight MAP plans that are using the integrated grievance and appeals process (Elderplan, Healthfirst, VNSNY, Riverspring, Senior Whole Health, Centers Plan, Village Care and Agewell). Not all MAP plans are currently eligible to use the integrated appeals process due to not being fully aligned. However, NYSDOH reports that there are MAP plan applications under review so additional MAP plans may soon be offering integrated grievances and appeals. 

Under this demonstration MAP grievances and appeals are integrated, which means a beneficiary uses a single process regardless of whether their denial is for a Medicare or Medicaid covered service. The demonstration intends to ease the appeals process for dually eligible individuals enrolled in MAP plans. 

For more information on MAP integrated appeals, visit Medicare Interactive.

Enrolling in Medicare during the coronavirus public health emergency

During the coronavirus public health emergency, local Social Security offices are closed to the public, but many services are available online and over the phone.

• Online Medicare applications can be found and submitted here: https://www.ssa.gov/benefits/medicare/ 
• Answers to some questions can be found online, or beneficiaries can call the national Social Security Administration helpline at 800-772-1213
• Local Social Security offices may also be able to help

Many people can use the online application to apply for Medicare, particularly to enroll in Part A and Part B at the same time if they have not enrolled in Medicare before. Those who cannot enroll in Medicare online should contact their local Social Security office. These individuals will likely need to mail or fax paperwork.

Medicare has also made temporary changes to a process called equitable relief so that individuals can request more time to enroll in Medicare Part B (or premium Part A). For more information, please visit Medicare Rights’ blog. 

Medicare Advocacy Toolkits provide guidance for New York advocates helping beneficiaries navigate complex Medicare topics 

Medicare Rights has released two toolkits, which were developed for New York advocates helping older adults and people with disabilities navigate Medicare. While these toolkits are intended for a New York audience, they may offer lessons to other states and be useful resources as advocates and policymakers think about ways to improve the federal Medicare program.

Medicare Advocacy Toolkits will roll out in 2020, with covered topics including:

• Medicare enrollment
• Durable medical equipment (DME) access
• Medicare for individuals with End-Stage Renal Disease (ESRD)
• Part D drug access

To view the toolkits, visit Medicare Interactive. Support for this work was provided by the New York State Health Foundation (NYSHealth). 

New York State and Federal Government Updates

Internal Revenue Service releases new electronic portal

The Internal Revenue Service (IRS) released a new electronic portal to assist people receiving Supplemental Security Income, recipients of certain Veterans Affairs (VA) benefits, and others in accessing federal stimulus payments. Individuals can go to the portal, enter their personal information, and receive their stimulus payment. 

The Social Security Administration and U.S. Department of the Treasury announced that SSI recipients with no dependent children (for whom they would be eligible to receive an additional $500) will receive stimulus checks automatically. Those with qualifying children will need to provide additional information via the portal above. 

For more information, see the U.S. Department of the Treasury’s press release.