Expanding Medicare on political agendas: In-home Health Care critically important

Published in RINewsToday on October 14, 2024

This week Vice President Kamala Harris unveiled a “Medicare at Home” proposal on ABC’s The View that would expands Medicare to assist older Americans to age in place at home by covering some of the cost of in-home care. The proposal targets adults who are part of the ‘sandwich generation,’ estimated to be 105 million Americans who are raising children along with taking care of their elderly parents.

The Medicare benefit to assist caregivers would propose to have cost-saving benefits for the federal government by allowing seniors to stay at home rather than being sent to costly nursing homes. It would also reduce hospitalizations, too.

Harris told about her personal experience as a caregiver, providing care to her mother, Shyamala Gopalan, a biomedical scientist, who died of cancer in 2009 at the age of 70. Caring for a parent can translate into “trying to cook what they want to eat, what they can eat,” she said. “It’s even trying to think of something funny to make them laugh or smile,” she added.

“We’re talking about declining skills” of older people, “but their dignity, their pride, has not declined,” Harris added.

“There are so many people in our country who are right in the middle. They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work,” Harris said. “…we’re finding that so many are having to leave their job, which means losing a source of income, not to mention the emotional stress,” she said, explaining why there is a need to expand Medicare to cover more in-home care services.

Harris’ Issues on her website – Protect and Strengthen Social Security and Medicare

“Vice President Harris will protect Social Security and Medicare against relentless attacks from Donald Trump and his extreme allies. She will strengthen Social Security and Medicare for the long haul by making millionaires and billionaires pay their fair share in taxes. She will always fight to ensure that Americans can count on getting the benefits they earned”.

The Costs

The Brookings Institution recently estimated that a “very conservatively designed” program would cost $40 billion a year. They noted that “controlling demand in such a program is nearly impossible – for reference, Medicaid, which covers far fewer adults than Medicare, actually spent $207 billion on long-term services and supports in 2021”.

In addition, “Home health is such a hotbed of fraud,” said Theo Merkel, a health policy expert at the Paragon Health Institute and the Manhattan Institute. “If the proposal is adopted, taxpayers could end up paying for everyone who stays at home with their Medicare-eligible family member as a government paid Service Employees International Union member.”

The Cato Institute, a libertarian think tank headquartered in Washington, D.C., charges that Harris’ new Medicare home care benefit is “uncompassionate, fiscally reckless, and a corrupt attempt to buy the votes of Medicare enrollees and their middle-aged children in an election year.”

Examining the Differences…

According to Matthew E. Shepard, Communications Director for the Center for Medicare Advocacy, the new Harris proposal is quite different from the existing home care benefits that Medicare’s 65.5 million enrollees receive. ”The new proposal focuses on Long Term Services and Supports, something of a term of art in the health care world. While details are scarce, it would provide, we believe, ongoing affordable home care aide service without a need for skilled care or that strict definition of homebound,” said Shepard. The proposal’s funding would come from increased savings in Medicare Part D as the list of negotiable drugs grows [a historic provision of the Inflation Reduction Act which is lowering the cost of senior’s medication] savings currently estimated at $6 billion in 2026, and which will only grow as more drugs are added, he noted.

“We are going to save Medicare that money, because we’re not going to be paying these high prices [for drugs] and that those resources are then put to use in a way that helps a family,” Harris said.

The Trump proposal

The Trump/Vance campaign quickly issued a statement taking credit for already making a commitment to America’s seniors receiving at-home care, saying that Harris’ Medicare expansion policy was just following his lead. Former President Trump released his home care platform last summer, according to an Oct. 8th statement. “Specifically, President Trump will prioritize home care benefits by shifting resources back to at-home senior care, overturning disincentives that lead to care worker shortages, and supporting paid family caregivers through tax credits and reduced red tape,” noted the statement.

One of Trump’s 20 point platforms is “Fight for and protect social security and Medicare with no cuts, including no changes to the retirement age”. In the accompanying 16-page document, which, supports Medicare it says, “President Trump has made absolutely clear that he will not cut one penny from Medicare or Social Security. American citizens work hard their whole lives, contributing to Social Security and Medicare. These programs are promises to our Seniors, ensuring they can live their golden years with dignity. Republicans will protect these vital programs and ensure Economic Stability. We will work with our great Seniors, in order to allow them to be active and healthy. We commit to safeguarding the future for our Seniors and all American families. We will strengthen Medicare. Republicans will protect Medicare’s finances from being financially crushed by the Democrat plan to add tens of millions of new illegal immigrants to the rolls of Medicare. We vow to strengthen Medicare for future generations.”

Dementia caregiving already set to quadruple in 2025

AARP notes on their website that one expansion of caregiver coverage, “a program for dementia patients and their caregivers that launched this year will quadruple in 2025, serving more of the country. The program, called Guiding an Improved Dementia Experience (GUIDE), provides a 24/7 support line, a care navigator to find medical services and community-based assistance, caregiver training and up to $2,500 a year for at-home, overnight or adult day care respite services. Patients and their caregivers typically won’t have copayments”.

Praise for expanding Medicare benefits

“We have long championed the expansion of federal support for long-term care,“ says Max Richtman, President and CEO, National Committee to Preserve Social Security and Medicare (NCPSSM), noting that Harris’ proposal gives that cause an enormous boost.

“Expanded Medicare coverage for home health care also would provide relief to millions of ‘sandwich generation’ Americans, who are struggling to provide care for their elderly relatives while also raising children. Those ‘sandwich generation’ members are not Medicare beneficiaries, but would most definitely benefit from Harris’ long-term care plan,” says Richtman in an Oct. 8 statement.

According to Richtman, the plan also would add hearing and vision coverage to traditional Medicare. “Proper hearing and vision care are essential to healthy aging — but too many beneficiaries forgo it due to cost and lack of coverage. It is long past time that those coverages be added,” he added.

Co-Director David Lipschutz says that the Center for Medicare Advocacy (CMA) strongly supports the proposed enhancement of Medicare coverage for on-going home care. “Access to services and supports in the home for those who are unable to independently perform activities of daily living would provide immeasurable help to millions of beneficiaries and their families and is an important step forward for the Medicare program,” says CMA’s Lipschutz. To maximize access to care for people who need it, expansion of home care coverage in Medicare should be combined with enforcing the benefit that exists now, he suggests.

“Recognizing that most older persons and those with disabilities prefer to remain at home when they need help with daily living tasks, the Senior Agenda Coalition has worked for years to increase access to home and community-based care at the state level as these services are one of the biggest gaps in Medicare,” says Maureen Maigret, Policy Advisor for Senior Agenda Coalition of RI. To include them in Medicare will lift a financial burden on both recipients and family caregivers as home care costing at least $35/hour that can be out of reach for far too many who need these services to stay at home,” she says.

“We have not seen many details about the plan, but it would be important to make sure that Medicare provider reimbursement levels are sufficient to allow direct care staff to earn livable wages in order to have workforce sufficient to meet the demand,” note Maigret. “This new Medicare home care benefit should also be a boon for states as it can prevent persons from spending down their resources to a level where they become eligible for state Medicaid and need costly nursing home care,” she says.

In a new paper for O’Neill Institute for Georgetown Law, McCourt Professor Judith Feder and Nicole Jorwic explore how adding a home care benefit can help beneficiaries and family caregivers. “While this new benefit would not reach the full population in need of long-term care, paired with investments in Medicaid, it’s a good strong start-and given our nation’s resources, clearly within our means,” say the authors.

“A support system that relies on unpaid family members and underpaid workers is simply not sustainable for the future,” warn the authors.

“Our failure to make Medicare “whole” by addressing Long Term Services and Support needs is not about a shortage of resources, it’s about a shortage of political will. It’s time the nation stepped up,” they say.

Pay attention to Caregiver voters

AARP is nonpartisan and does not take a position on campaign proposals, though AARP has previously said financial relief is needed to help individuals age in place at home and support family caregivers, says Sarah Lovenheim, AARP’s vice president, external relations.

According to AARP’s “She’s the Difference” survey released last month, 96% of woman aged 50 and over say they are highly motivated to vote in the upcoming elections, making them one of the most driven and key voting groups.

“Any political candidate would be wise to pay attention to the concerns and needs of caregivers today. Voters over age 50, who disproportionately make up America’s 48 million plus caregivers, could make or break elections up and down the ballots,” says Nancy LeaMond, AARP’s executive vice president and chief advocacy and engagement officer. “From recent battleground polls, we know that roughly one-third of swing voters over age 50 identify as family caregivers,” she notes.

“Supporting family caregivers is an urgent need – not only for families struggling to get by but for our country’s future,” warns LeaMond.

Regardless of who wins the election, a Medicare at home proposal cannot happen without Congressional support. As the presidential campaign winds down, older voters must make it extremely clear to lawmakers seeking their vote how they feel about expanding Medicare benefits.

Social Security 2025 COLA expected to be small increase

Published in RINewsToday on September 16, 2024

Stay tuned… Next year’s cost-of-living adjustment (COLA) will be announced by the Social Security Administration (SSA) in mid-October, upon the release of September’s annual inflation adjustment data. SSA’s COLA for 2025 will be reflected in beneficiary checks starting in January of that year. Like clockwork, this happens annually, although beneficiaries may see their payments occasionally arrive a few days early due to holidays or weekends.

The Senior Citizen’s League (TSCL) releases its COLA projections each month. The official COLA is determined by the Labor Bureau’s revised CPI-W data from July, August and September.

Some say SSA’s 2025 COLA is “Chump Change”

With one month left, TSCL’s latest COLA model results, released on Sept. 11, 2024, predicts that next year’s COLA will be 2.5 % based on a decline from 2.9% to 2.5% in consumer price data. While 2.5% is lower than the 3.2% received in 2024, that wouldn’t be far from the historical norm. The COLA has averaged about 2.6% over the past 20 years. It went as low as 0.0% in 2010, 2011, and 2016 and as high as 8.7% in 2023.

According to TSCL, by law, the annual inflation adjustment is based on the average inflation during July, August, and September as measured by the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). The Bureau of Labor Statistics averages the CPI-W for these three months and then compares it with the same timeframe from the previous year, says the Alexandria-based nonprofit advocacy group whose mission is to protect Social Security, Medicare, and veteran or military retiree benefits.

TSCL’s COLA latest analysis findings indicates that next year’s COLA of 2.5% would raise the average monthly benefit for retired workers of $1,920 by $48 or about $564 annually. The modest increase will not enable seniors to cover increasing cost of living expenses (including food, clothing, transportation, energy, and shelter costs). “Rising grocery prices is creating food insecurity for many retirees. Feeding America estimated that 5.5 million Americans age 60 and above suffered from food insecurity in 2021, in the most recent study available on the subject, and that number is likely higher today,” note the researchers.

“Due to a higher cost of living, older Americans are using more and more of their income each month just to get by compared to a year ago. “Sixty-five percent of seniors reported monthly expenses of at least $2,000, up from 55% in 2023,” says TSCL’s COLA analysis, noting that statistical testing shows that there’s almost no chance that this gap is due to noisy survey variation. (The 2024 survey had 2,129 respondents; 2023 had 2,258 respondents.)

But low-income seniors aren’t the only ones who have seen their expenses rise, either, say the researchers, noting that more seniors are spending at least $4,000 or $6,000 per month compared to 2023, too, while fewer are able to get by on $1,000 or less. TSCL says that a rise in monthly expenses wouldn’t be much of an issue if seniors’ higher expenses were going to fun activities things, like activities with their grandchildren, or discretionary costs, like bucket-list vacations. However, this is not the case, says the Social Security advocacy group. “Nearly 80% of senior households in the 2024 survey reported that their monthly budget for essential items like food, housing, and prescription drugs had increased over the last 12 months, with 63% saying they’re worried that their income won’t be enough to cover these basic costs in the coming months,” says the analysis findings.

Over the years, TSCL, along with other aging advocacy groups including the National Committee to Protect Social Security (NCPSSM) and Social Security Works, have called for higher COLAs.

Calls for Congress to change current COLA formula.

Last March, in correspondence to Sen. Bob Casey, Jr. (D-PA), chairman of the U.S. Senate Special Committee on Aging, NCPSSM, the Washington DC based Social Security advocacy group endorsed Casey’s legislative proposal, S. 3974, entitled the “Boosting Benefits and COLAs for Seniors Act.” The proposal has been referred to the Senate Finance Committee.

Specifically, Casey’s legislative proposal, introduced March 19, 2024, would direct SSA to adjust benefits based on CPI-E rather than CPI-W, if CPI-E would result in a larger increase in benefits. The Bureau of Labor Statistics (BLS) would calculate and publish the CPI-E on a monthly basis. The Senator believes it would be the most accurate measure of the real effect of inflation on the goods and services that are purchased by America’s seniors.

In NCPSSM’s correspondence, CEO and President Max Richtman strongly supported Casey’s call for requiring BLS to change the way it calculates SSA’s annual COLAs, using a CPI-E formula.

According to Richtman, SSA’s current formula for calculating COLAs is based upon the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W), which is a measurement by the BLS of the changes in the prices paid for a market basket of goods and services purchased by urban wage earners and clerical workers.

“The current CPI-W has fallen far short of providing needed inflation protection because it fails to adequately measure the spending patterns of seniors,” says Richtman in his endorsement of Seniors typically spend more on out-of-pocket health care costs than other Americans, and in most years, the cost of health care rises more quickly than general inflation,” he says. “We believe adoption of your bill would go a long way toward protecting those on fixed incomes from the ravages of inflation,” says Richtman.

The following organizations have endorsed S. 3974: Arc of the United States; Alliance for Retired Americans; American Federation of Government Employees; American Federation of State, County and Municipal Employees; California Alliance for Retired Americans; Justice in Aging; National Committee to Preserve Social Security and Medicare; National Education Association; National Organization of Social Security Claimants Representatives; Social Security Works; Strengthen Social Security Coalition.

While former President Donald Trump and Vice-President Kamala Harris have both pledged to protect Social Security, nether have put out a specific plan to keep America’s retirement program solvent.

According to the last Social Security Trustees report, the Social Security Old-Age and Survivors Insurance trust fund is projected to be depleted by 2033 at which point SSA will be forced to make a 21 percent across the board reduction. The nonpartisan Committee for a Responsible Federal Budget estimates that this would be a $16, 500 cut in annual benefits for a typical dual-income couple retiring at the time of trust fund depletion.

When the dust settles after the upcoming presidential election, the new president must make it a priority to hammer out a bipartisan fix along with pushing for requiring BLS to use the CPI-E Formula to accurately predict the impact of inflation on America’s retirees.

Social Security changes expand access to SSI

Published in RINewsToday on May 20, 2024

Last week, the Social Security Administration (SSA) announced good news for Supplemental Security recipients. The federal agency published a final rule on April 19, 2024, to – “Expand the Definition of a Public Assistance Household.” The regulation announces one of several updates to Supplemental Security Income (SSI) regulations that will help people receiving and applying for SSI.

SSA continuously examines programmatic policy and makes regulatory and sub-regulatory changes as appropriate. SSI is a means-tested program providing monthly payments to adults and children with a disability or blindness, and to adults aged 65 and older. These benefits help pay for basic needs like rent, food, clothing, and medicine. People applying for and receiving SSI must meet eligibility requirements, including income and resource limits.

According to SSA’s Office of the Chief Actuary, once this rule is implemented and the effects have stabilized, in fiscal year 2033 its estimated that roughly 277,000 federal SSI recipients (4 percent of all SSI recipients) will have an increase in monthly payments compared to current rules, and an additional 109,000 individuals (1% increase) will receive Federal SSI payments who would not have been eligible under current rules. As of December, 2022, there were approximately 30,500 people in Rhode Island receiving SSI benefits.

SSA expands access to SSI program

Under SSA’s final rule (20 CFR Part 416), beginning September 30, 2024, the agency will expand the definition of a public assistance household to include households receiving Supplemental Nutrition Assistance Program (SNAP) payments and households where not all members receive public assistance. The expanded definition will allow more people to qualify for SSI, and increase some SSI recipients’ payment amounts. It also reduces reporting burdens for individuals living in public assistance households.

The SSA revised rule also changes the definition of a public assistance household when determining who in a household receives public assistance. The new rule defines a public assistance household as one that has both an SSI applicant or recipient, and at least one other household member who receives one or more of the listed means-tested public income-maintenance (PIM) payments (the any other definition).

The previous policy required all household members to receive public assistance. This change benefits SSI recipients living in households where only some members receive public assistance.

“I’m committed to making systemic changes to help people access the critical benefits they need, including SSI,” said Martin O’Malley, Commissioner of Social Security, in a May 9, 2024 statement announcing the release of the final rule. “By simplifying our policies and including an additional program geared towards low-income families, such as [those receiving] SNAP, we are removing significant barriers to accessing SSI. These changes promote greater equity in our programs.”

SNAP is the first PIM benefit added to the agency’s public assistance household definition since it was established in 1980. This change helps ensure the agency’s policies better represent the current landscape of means-tested programs in the United States, according to SSA.

These changes are key because if an applicant or recipient is determined to be living in a public assistance household, the agency assumes they are not receiving assistance from other household members that would otherwise be counted as income. This will allow more people to qualify for SSI and in some cases, receive a higher SSI payment.

Thumbs Up from aging network

“I commend the Biden administration for this needed expansion of the SSI program. It is a recognition that those in the greatest economic need in our nation need help. By expanding the definition of a public assistance household, it will not only allow more people to qualify for SSI but can also increase some existing SSI recipient’s payment amounts,” says Robert B. Blancato, Executive Director of the Washington, DC-based National Association of Nutrition and Aging Services Program, noting that programs such as SSI and SNAP are safety net programs for those who are truly [in need].

“It is disingenuous to lose qualification for one safety net program because of being eligible for another. The role of the federal government is to assist those most in need while minimizing bureaucratic red tape. This final rule shows a level of compassion we need to see more of in federal policy,” adds Blancato.

According to Maria Freese, Senior Legislative Representative at the Washington, DC-based National Committee to Preserve Social Security and Medicare, this new rule will take an important step toward simplifying some of the most complicated and burdensome rules governing the SSI program. SSI’s in-kind support and maintenance (ISM) rules reduce benefits dollar-for-dollar for the value of support from family or friends, such as a place to sleep, or help with groceries, up to one-third of benefits. SSI is the only federal program to reduce benefits in this manner. “While fewer than 1 in 10 SSI beneficiaries receive ISM, the current ISM rules make the program more complicated for nearly every SSI beneficiary. SSA is required to ask detailed, personal, and complicated questions concerning living arrangements, other household members and budgeting, not only once but repeatedly as family circumstances change,” she says.

Freese added: “Groups living together who qualify as ‘public assistance households’ are exempt from these reporting requirements, but the previous definition, which required that every member of the household receive public assistance, limited the ability of low-income beneficiaries to take advantage of the exemption. The new rule requires only one SSI beneficiary and one additional member of the household be a recipient of public assistance, and expands the qualifying programs to include the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps).”

“This new rule will lessen hardship for struggling, low-income families, simplify the administration of the SSI program and lower costs and staff time for the Social Security Administration, which has been chronically underfunded. It represents good public policy, and reflects well on an agency working hard to provide the benefits working families deserve,” notes Freese.

According to Nancy Altman, President and CEO of the Washington, DC-based Social Security Works, this rule is an important step towards improving the Supplemental Security Income program (“SSI”). “Currently, SSI forces the most disadvantaged Americans to jump through numerous time-consuming, complicated, and burdensome hoops simply to get below-poverty level benefits. Simplifying the numerous burdensome requirements will not only ease the lives of those whom government is intended to serve, it will also reduce administrative costs,” she says.

“Ultimately, Congress needs to act to improve SSI, as well as adequately fund the SSA so it can hire and train enough staff to properly administer the program. In the absence of action from Congress, the Biden administration is doing what it can on its own, including this and other rule changes, says Altman.

Altman suggests that if Congress and the Social Security Administration truly want to save administrative costs and provide more accurate and timely payment amounts, more rules like these should be adopted and the laws governing SSI should be updated and simplified.”

With Social Security’s long-term purchasing power dwindling and heightening financial uncertainty for recipients, the League supports updating the definition of public assistance for beneficiaries receiving SSI, says Shannon Benton, Executive Director of the Alexandria, Virginia-based Senior Citizens League. “’The increased inability of seniors to make ends meet remains a pressing concern of The Senior Citizens League, and it should also be a pressing concern of Congress,” she says.

Adds Associate Director Kathleen Holt, of the Connecticut-based Center for Medicare Advocacy, “The expanded definition of ‘public assistance household’ is a thoughtful, focused way to ensure the dignity and needs of individuals in a residence are upheld.”

For more information on the SSI program, including who is eligible and how to apply, visit https://www.ssa.gov/ssi.

To read the final rule “Expand the Definition of a Public Assistance Household,” visit https://www.federalregister.gov/documents/2024/04/19/2024-08364/expand-the-definition-of-a-public-assistance-household.

For further details about the final rule, contact Tamara Levingston, Office of Income Security Programs, 6401 Security Blvd., Robert M. Ball Building, Suite 2512B, Woodlawn, MD 21235, 410-966-7384.