Tag Archives: Medicaid

Why The Senior Vote Matters!

Senior citizens have always been a very reliable voting bloc in the United States.  We assume that this is because they have the time to go vote.  While that might be somewhat true, the fact is that retired people are most vulnerable to any policy changes made by the government.  When Social Security constitutes a sizable part of your income and Medicare is your only option for health care, voting is much more than just your civic duty – it becomes the most important thing you must do to maintain your quality of life.

Just like all older voters, older Asian Voters are more likely to be registered and to vote. They reliably show up to the polls to vote in larger numbers than their younger brethren.  Infact, in presidential elections, voter turnout is even higher for foreign born Asians than those that are U.S. born.

According to the National Survey of Older Voters During COVID-19: Asian Americans, conducted by the Harris Poll on behalf of AARP, although 86% are “very likely” to vote in 2020, the majority of Asian American voters 50+ are not being engaged or contacted by either party affiliation (61%) or community organizations (74%), according to (AAVS).

This data is so puzzling but what does this mean and how does this impact this large voting bloc?  It means that this group is invisible.

When you think of a Asian American voter, your mind immediately conjures up a 30 something year old, highly educated person with a good paycheck; painting a picture of a young, educated, middle class person.  This image belies the fact that many of these voters are senior citizens or at least 50+ and this is the demographic that AARP  (American Association of Retired Persons) is interested in.

Turning 50 is life changing in many ways, but the significance of that particular number becomes even more acute when you receive your welcome package from AARP.  I am not old and I am certainly not retiring anytime soon you think and you are right.  But AARP is not just for old, retired people.

AARP is working to have your (50+)  voice heard on the issues that matter to this demographic.  Protecting social security and medicare, lowering prices of prescription drugs, and ensuring your right to vote safely among many other issues. While these might not be issues that are top of mind for you at 50, you know it will be very soon.

Speakers at the Oct 21 AARP briefing released new findings from recent national surveys exploring the key priorities and concerns of Asian American voters aged 50 and older. Results from the 2020 Asian American Voter Survey (AAVS), conducted by AAPI Data on behalf of AARP, APIAVote and Asian Americans Advancing Justice-AAJC, show that 93% of Asian Americans 50-plus view health care as important heading into the election, making it the top most important issue. Jobs and the economy follow as the second most important issue, with 89% of respondents citing them either as “extremely” or “very” important.

With over 50k+ nursing home deaths and the disproportionate vulnerability of our elders to the current pandemic, these survey results are not surprising. COVID-19 has underscored the importance of healthcare as a voter issue and has caused a sense of insecurity related to the economy, health, freedom from discrimination, elections and voting.

Additional findings from the survey on 50+ AAPI (Asian American & Pacific Islander)  – which is the category under which South Asians voters are aggregated include:

  • Plurality of older Asian voters identify as Democrat but the majority describe themselves as moderate.  They are more united around ideology than around a party affiliation.

  • Older asian voters value opportunity and freedom.  They also value entrepreneurial spirit, respecting people with different ideologies and have a greater willingness to accept refugees.

  • Majorities of older Asian American voters support action for equality and equity and agree that there is racial and ethnic discrimination in this country.

  • 50+ Asian voters have become more progressive since the 2016 elections.

  • Over 75% of the older Asian voters get their election information from traditional media and about 42% from talking to their family.

If the 50+ Asian voter is so engaged and likely to vote, why are they not on the radar for either party? 

One piece of data that is striking is this :  85% of 50+ Asian American voters are foreign born. One reason for this opportunity gap is the need to reach out in different languages in order to communicate effectively with this community.

But the larger reason for this lack of engagement is education about the numbers and their impact.  “They don’t pay attention if there is no data,” says Daphne Kwok of AARP.  “But now we are proving that this cohort is an important part of the electorate.  For the political parties, it is so key that they start to hear from AAPI 50+” continues Kwok.  Our issues and concerns have to be raised and addressed.

“We have seen over the past election cycles, more and more AAPIs getting involved politically, voting, and hopefully our voice is starting to become louder.”  Kwok is also optimistic because it has also been proven in the last election that AAPIs have become the margin of victory in many races. Hopefully this is the incentive both parties see to reach out to this voting bloc that could make a difference for their candidate.

So let’s get out the Vote in our 50+ community.  Each state has different rules, different timelines, and different procedures.

Everything you need to know to vote safely is at aarp.org/election2020  and APIAvote.org.

Older voters are more likely to vote in person.  If there is a vulnerable senior citizen in your family, please take the proper precautions but help them make their vote count.

We can’t afford to let anyone’s vote go uncounted.


Anjana Nagarajan-Butaney is a Bay Area resident with experience in educational non-profits, community building, networking, and content development and was Community Director for an online platform. She is interested in how to strengthen communities by building connections to politics, science & technology, gender equality and public education.

image: BBH Singapore on Unsplash

The New Digital World Can Give Seniors A Hard Time

Family gatherings on Zoom and FaceTime. Online orders from grocery stores and pharmacies. Telehealth appointments with physicians.

These have been lifesavers for many older adults staying at home during the coronavirus pandemic. But an unprecedented shift to virtual interactions has a downside: Large numbers of seniors are unable to participate.

Among them are older adults with dementia (14% of those 71 and older), hearing loss (nearly two-thirds of those 70 and older) and impaired vision (13.5% of those 65 and older), who can have a hard time using digital devices and programs designed without their needs in mind. (Think small icons, difficult-to-read typefaces, inadequate captioning among the hurdles.)

Many older adults with limited financial resources also may not be able to afford devices or the associated internet service fees. (Half of seniors living alone and 23% of those in two-person households are unable to afford basic necessities.) Others are not adept at using technology and lack the assistance to learn.

During the pandemic, which has hit older adults especially hard, this divide between technology “haves” and “have-nots” has serious consequences.

Older adults in the “haves” group have more access to virtual social interactions and telehealth services, and more opportunities to secure essential supplies online. Meanwhile, the “have-nots” are at greater risk of social isolation, forgoing medical care and being without food or other necessary items.

Dr. Charlotte Yeh, chief medical officer for AARP Services, observed difficulties associated with technology this year when trying to remotely teach her 92-year-old father how to use an iPhone. She lives in Boston; her father lives in Pittsburgh.

Yeh’s mother had always handled communication for the couple, but she was in a nursing home after being hospitalized for pneumonia. Because of the pandemic, the home had closed to visitors. To talk to her and other family members, Yeh’s father had to resort to technology.

But various impairments got in the way: Yeh’s father is blind in one eye, with severe hearing loss and a cochlear implant, and he had trouble hearing conversations over the iPhone. And it was more difficult than Yeh expected to find an easy-to-use iPhone app that accurately translates speech into captions.

Often, family members would try to arrange Zoom meetings. For these, Yeh’s father used a computer but still had problems because he could not read the very small captions on Zoom. A tech-savvy granddaughter solved that problem by connecting a tablet with a separate transcription program.

When Yeh’s mother, who was 90, came home in early April, physicians treating her for metastatic lung cancer wanted to arrange telehealth visits. But this could not occur via cellphone (the screen was too small) or her computer (too hard to move it around). Physicians could examine lesions around the older woman’s mouth only when a tablet was held at just the right angle, with a phone’s flashlight aimed at it for extra light.

“It was like a three-ring circus,” Yeh said. Her family had the resources needed to solve these problems; many do not, she noted. Yeh’s mother passed away in July; her father is now living alone, making him more dependent on technology than ever.

When SCAN Health Plan, a Medicare Advantage plan with 215,000 members in California, surveyed its most vulnerable members after the pandemic hit, it discovered that about one-third did not have access to the technology needed for a telehealth appointment. The Centers for Medicare & Medicaid Services had expanded the use of telehealth in March.

Other barriers also stood in the way of serving SCAN’s members remotely. Many people needed translation services, which are difficult to arrange for telehealth visits. “We realized language barriers are a big thing,” said Eve Gelb, SCAN’s senior vice president of health care services.

Nearly 40% of the plan’s members have vision issues that interfere with their ability to use digital devices; 28% have a clinically significant hearing impairment.

“We need to target interventions to help these people,” Gelb said. SCAN is considering sending community health workers into the homes of vulnerable members to help them conduct telehealth visits. Also, it may give members easy-to-use devices, with essential functions already set up, to keep at home, Gelb said.

Landmark Health serves a highly vulnerable group of 42,000 people in 14 states, bringing services into patients’ homes. Its average patient is nearly 80 years old, with eight medical conditions. After the first few weeks of the pandemic, Landmark halted in-person visits to homes because personal protective equipment, or PPE, was in short supply.

Instead, Landmark tried to deliver care remotely. It soon discovered that fewer than 25% of patients had appropriate technology and knew how to use it, according to Nick Loporcaro, the chief executive officer. “Telehealth is not the panacea, especially for this population,” he said.

Landmark plans to experiment with what he calls “facilitated telehealth”: nonmedical staff members bringing devices to patients’ homes and managing telehealth visits. (It now has enough PPE to make this possible.) And it, too, is looking at technology that it can give to members.

One alternative gaining attention is GrandPad, a tablet loaded with senior-friendly apps designed for adults 75 and older. In July, the National PACE Association, whose members run programs providing comprehensive services to frail seniors who live at home, announced a partnership with GrandPad to encourage adoption of this technology.

“Everyone is scrambling to move to this new remote care model and looking for options,” said Scott Lien, co-founder and chief executive officer of the company, which is headquartered in Orange County, California.

PACE Southeast Michigan purchased 125 GrandPads for highly vulnerable members after closing five centers in March where seniors receive services. The devices have been “remarkably successful” in facilitating video-streamed social and telehealth interactions and allowing nurses and social workers to address emerging needs, said Roger Anderson, senior director of operational support and innovation.

Another alternative is technology from iN2L (an acronym for It’s Never Too Late), a company that specializes in serving people with dementia. In Florida, under a new program sponsored by the state’s Department of Elder Affairs, iN2L tablets loaded with dementia-specific content have been distributed to 300 nursing homes and assisted living centers.

The goal is to help seniors with cognitive impairment connect virtually with friends and family and engage in online activities that ease social isolation, said Sam Fazio, senior director of quality care and psychosocial research at the Alzheimer’s Association, a partner in the effort. But because of budget constraints, only two tablets are being sent to each long-term care community.

Families report it can be difficult to schedule adequate time with loved ones when only a few devices are available. This happened to Maitely Weismann’s 77-year-old mother after she moved into a short-staffed Los Angeles memory care facility in March. After seeing how hard it was to connect, Weismann, who lives in Los Angeles, gave her mother an iPad and hired an aide to ensure that mother and daughter were able to talk each night.

Without the aide’s assistance, Weismann’s mother would end up accidentally pausing the video or turning off the device. “She probably wanted to reach out and touch me, and when she touched the screen it would go blank and she’d panic,” Weismann said.

What’s needed going forward? Laurie Orlov, founder of the blog Aging in Place Technology Watch, said nursing homes, assisted living centers and senior communities need to install communitywide Wi-Fi services — something that many lack.

“We need to enable Zoom get-togethers. We need the ability to put voice technology in individual rooms, so people can access Amazon Alexa or Google products,” she said. “We need more group activities that enable multiple residents to communicate with each other virtually. And we need vendors to bundle connectivity, devices, training and service in packages designed for older adults.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

A Conversation With Children’s Advocate Mayra Alvarez

School lunch programs, which fed nearly half of American’s schoolchildren before the Coronavirus, have turned into a lifeline for families hit by unemployment and rising food prices during the pandemic.

Many of those programs are now going broke, and their very existence over the next decade depends on the population numbers being gathered by the U.S. Census in communities that are considered “hard to count,”  says Mayra E. Alvarez, President of The Children’s Partnership, a nonprofit which advocates for underserved children.

When asked about the impact of the U.S. Census, which is conducted every ten years and has been delayed and disrupted (but NOT canceled) by the pandemic, Alvarez mentions this program first, although it’s hardly the only one that would be affected if there is a severe undercount of children and low income families.

In the past three months, school lunch programs have lost at least $1 billion during lockdowns and school closures that eliminated the revenue from families who were able to pay for the meals.

At the same time, costs have outstripped federal reimbursements for the emergency meals. Relief bills passed by Congress have helped, but the long-term survival of the programs depend on data from the 2020 Census.

For populations concerned with survival, filling out or responding to the 2020 Census may seem a distant priority.

But nothing is more important for vulnerable families than an accurate count, says Alvarez.

For starters, the biggest, most impactful federal and state programs that serve the health and well-being of children and families depend on formulas driven by census data.

The more people that are counted, particularly in those communities that need a variety of programs, the more money is allocated to serve them.

“We can point to Medicaid and CHIP (Children’s Health Insurance Program), two fundamental programs for health care, which are partly based on census numbers,” said Alvarez.

“The programs that rely on census data are the ones the majority of people rely one, like Medicaid, food stamps, cash assistance”.

Medicaid, for example, is “part of a formula that distributes money to states, based on population and income; the states put money in and the federal government matches it.”

Experts estimate that the federal government provides between $1,700 and $2,000 for each person counted in the census.

For a minimum wage earner who’s a single mother of two, being counted or not counted in the census “can make a whole world of difference,” Alvarez says.

“If there is no adequate reflection of people like her in the census data, she may not be able to qualify for food stamps or enroll her children in child care because there won’t be enough slots”, Alvarez explains.

”She may also lose out on health coverage for her children, not find space in a neighborhood school and have to bus her children to another school. She might have to go farther away to find a hospital if the child gets sick because the hospital wasn’t built in her community since the population count did not reflect her presence,” she continues.

“This could be a very dire situation if the undercount is severe.”

“It is so much more important to be accurate right now because so many families are struggling,” Alvarez says. “These programs pretty much impact every aspect of their lives”.

Going back to school lunches, Alvarez says, an undercount of children and families could mean more hunger at a time when it’s unclear how soon will schools be able to go back to some kind of “normality”

“If families that have kids that depend on free and reduced lunch are undercounted, there will not be as many resources to make sure they are eating when they go to school”, Alvarez says. “These are kids that may not be able to eat at home or bring money for lunch”.

Many Nursing Homes Are Failing the Coronavirus Stress Test

Long before the novel coronavirus made its surprise appearance, the nation’s nursing homes were struggling to obey basic infection prevention protocols designed to halt the spread of viruses and bacteria they battle daily.

Since the beginning of 2017, government health inspectors have cited more nursing homes for failing to ensure that all workers follow those prevention and control rules than for any other type of violation, according to a Kaiser Health News analysis of federal records.

In all, 9,372 nursing homes, or 61%, were cited for one or more infection-control deficiencies, the analysis showed. It also found violations were more common at homes with fewer nurses and aides than at facilities with higher staffing levels.

Even among nursing homes crowned with the maximum government rating of five stars for overall quality, 4 in 10 have been cited for an infection-control lapse. Those include the Life Care Center of Kirkland, Washington, a Seattle suburb, where  five people who had lived at the facility have died.

Inspection reports from around the country show many errors are rudimentary, such as workers not washing their hands as they moved to the next patient, or failing to don masks, gloves and gowns when in the rooms of contagious patients in isolation.

“It’s all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak,” said Patricia Hunter, the Washington State Long-Term Care Ombuds, who addresses complaints from residents and families and pushes for improvements in facilities.

In recent years, the federal government has been ramping up the standards for nursing homes, but inspectors remain frustrated by the prevalence of sloppy or nonexistent handwashing. “We have got to do better on handwashing,” Evan Shulman, the director for the nursing home division of the Centers for Medicare & Medicaid Services, told an association of nursing home directors in 2018.

While citations are rampant across the industry, health inspectors have classified all but 1% of violations as minor and not warranting fines, the KHN analysis found. A single low-level citation usually has limited impact on the overall star rating, the only metric most consumers examine.

The coronavirus has demonstrated its potential lethality among the old and frail in Kirkland, but the infections that nursing homes already battle with mixed success — influenza and antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA) — can be equally fatal. As many as 3.8 million infections occur in nursing homes each year, killing nearly 388,000 residents.

Dr. David Gifford, the chief medical officer for the American Health Care Association, the primary nursing home trade group, told reporters Monday that these facilities were ready to deal with coronavirus infections through the prevention plans they have in place. “We prepare for seasonal influenza every year — it’s very similar to that,” he said.

“We are reinforcing the information for basic procedures for how to prevent the spread,” he added, such as keeping infected residents away from others and having sick employees stay home.

Yet the same industry deficits that have hampered past infection-control efforts are in play with the coronavirus. Nursing homes experience frequent staff turnover, and new or temporary workers are less likely to be familiar with a facility’s protocols. Also, inspectors have found that these homes have had difficulty making sure that potentially infected workers stay home, a problem compounded by the low pay and limited time-off benefits many receive.

During a norovirus outbreak in 2017 at another Washington state nursing home, for instance, at least six infected employees returned to work earlier than they were supposed to. Inspectors discovered the virus ultimately spread to 32 employees and 43 residents — more than 40% of those living in the home, according to an inspection report.

Even if nursing homes are successful in getting infected workers to take days off, they may run into trouble finding replacements. Dr. David Nace, director of long-term care and flu programs at the University of Pittsburgh Department of Medicine, said staffing issues are compounded by a national shortage of healthcare workers. “Facilities may be faced with the issue of closure if they don’t have the staffing,” he said.

KHN’s analysis found that 53% of homes with the most nurses and aides — which CMS awards five stars for staffing on its Nursing Home Compare website — had been cited for infection-control violations in the past three years, while 65% of homes with the fewest staff — garnering only one star — were cited for the same type of failing. The staffing stars make up one component of the overall rating.

“So many times, when there aren’t enough staff, the aides and nurses are literally trying to do 50 things at once, running from person to person,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, a nonprofit based in Washington, D.C. “That’s when things fall through the cracks, like handwashing, which is the most useful thing to do to prevent infections.”

More sparsely staffed nursing homes were also cited more often: one-star facilities averaged 1.5 deficiencies while five-star facilities averaged 1.3 deficiencies. But out of more than 13,000 citations for infection-control lapses, regulators classified only 109 as serious harms or threats to patients. That finding echoed the results of a similar investigation KHN conducted in 2017. “It shows how ineffectual the enforcement situation is,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy.

One such violation was cited last April at the Kirkland nursing home after inspectors there observed a registered nurse treating a patient whose feet were touching the floor, even though one heel had a pressure sore that the resident’s daughter said she feared was infected. “It was unhygienic,” the daughter told inspectors.

Inspectors also watched another nursing home employee work in the room of a patient with pneumonia without wearing a mask, gown and gloves as required by a sign outside the room. They noted in their report that the facility had experienced two outbreaks of influenza that year, affecting at least 17 residents and seven staff members all told. Inspectors labeled the violations they observed as low level because they caused “minimal harm or potential for actual harm.” The nursing home pledged to reeducate staff on procedures and investigators found no problems when they revisited two months later.

Life Care Center, in an upscale, wooded neighborhood less than a mile from Lake Washington’s popular Juanita Beach Park, said in a statement released Monday that it is screening workers before they start work and after and has suspended visits and new admissions.

“We are also following infection control recommendations, including proper hand-washing techniques and wearing masks, gowns and gloves when caring for any symptomatic patients,” the statement said. The facility declined to discuss its previous citation.

Seema Verma, the CMS administrator, said during a press briefing at the White House Tuesday night that her agency is sending inspectors to the nursing home, as well as a hospital and dialysis center that treated coronavirus patients, to see if federal health and safety regulations were followed.

Hunter, the Washington state ombud, said that during her recent visits to 14 nursing homes in three Northwestern states, she observed that aides were generally good about using hand sanitizer but rarely washed residents’ hands. Not every resident room had a sink, she said. “I haven’t seen one resident have their hands washed during lunchtime or dinnertime,” she said.

While some nursing homes are making concerted efforts, “there are nursing homes that are really dirty and there are concerns that they’re not getting the job done,” Hunter added.” The trouble is when you don’t have enough workers, or you don’t have a stable workforce that’s trained to follow your protocol, that’s a weakness in the system.”

In 2016, CMS updated and expanded its infection-control rules, requiring among other things that each facility appoint one person to be in charge of infection control. CMS required the employee in that position, known as an infection preventionist, to complete specialized training and work at the facility either part time or full time. The Trump administration has proposed eliminating the on-site requirement.

Instead, CMS proposed the preventionist be someone who has spent “sufficient time” at the facility to oversee its infection-control efforts. It has asked the public for advice on how to define sufficient.

“We believe this is an appropriate standard,” the agency wrote in its proposed rule, issued last July. “However, we are also concerned that there could be a substantial variance in how LTC [long-term care] facilities interpret this requirement.”

KHN senior correspondent JoNel Aleccia contributed to this report.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Trump’s Fear Tactics Find Favor with Supreme Court Ruling on Public Charge

On Jan 27 the Supreme Court, in a 5-4 ruling, lifted an injunction on the Trump administration’s Public Charge Rule, which allows the Department of Homeland Security (DHS) to implement a policy that denies green cards and permanent resident visas to low-income immigrants and certain categories of legal immigrants, on grounds of inadmissibility.

DHS announced that the rule will take effect nationwide on February 24, 2020. 

Critics like Congresswoman Judy Chu say that entering America now comes with a price tag – the rule favors white and wealthy immigrants, and racially discriminates against poorer immigrant families. 

The National Council of Asian Pacific Islander Physicians (NCAPIP) denounced the Supreme Court decision as an “anti-American, anti-immigrant, inhumane policy (that) is not only unethical, but short sighted and a detriment to the vitality and health of our communities.”

In effect, the policy discourages lawful residents that the government deems likely to rely on public benefits, from using vital human services like Medicaid, food stamps and other government benefits, in case that jeopardizes their path towards permanent residency, and by extension, citizenship. 

A telebriefing on how the Supreme Court’s decision on the Public Charge rule impacts immigrants, was hosted by the Protecting Immigrant Families Campaign in partnership with Ethnic Media Services on Friday, January 31. A panel of experts explained the next steps planned by advocacy organizations and congressional allies, and what at-risk immigrants should do. 

The panel featured Congresswoman Judy Chu, Mayra Alvares, President of The Children’s Partnership, Alvaro Huerta of the National Immigration Law Center and Madison Allen, senior policy attorney at CLASP and Co-Chair of the Protecting Immigrant Families Campaign.


Who is Affected

“The harm is evident” said Madison Allen, describing how vulnerable communities are responding to miscommunication and anti-immigrant rhetoric about Public Charge regulations. Families confused about how Public Charge impacts them are disenrolling from housing, nutrition and medical benefits programs that are essential to their health and wellbeing. 

USCIS  lists age, health, family status, assets, resources, financial status, education, and skills as key factors that will be used to determine who meets the definition for public charge . “No single factor, other than the lack of an affidavit of support, if required, will determine whether an individual is a public charge.”

The law mainly affects immigrants applying for permanent resident status through family member petitions. There is a separate public charge test for people seeking visas from outside the country. 


Harmful Impact of Public Charge

The inadmissibility test with its expanded criteria on age, credit score and disability, will dramatically impact and reshape the immigrant system Allen points out, especially for people of color.

Unfortunately, the policy extends far beyond its intended recipients, says Mayra Alvarez of the Children’s Partnership (LA). Kaiser Family Foundation health centers report increasing numbers of immigrants disenrolling from medical coverage and 90 percent of providers in the survey reported increased anxiety among children. 

Social services and health centers across the country are documenting an increase in calls about whether it’s safe to stay enrolled in health, nutrition and housing programs, and, legal aid attorneys are fielding calls from sexual assault and domestic violence survivors who are fearful of staying enrolled in their benefits program even as they are trying to rebuild their lives. 

The ruling has created ‘a climate of fear’ that is negatively impacting the wellbeing of families who are worried at having to choose between food, medical care, and being together. People are withdrawing from benefits programs supported by tax dollars, even if they are exempt from the Public Charge rule, fearful that their receipt of public benefits will endanger their immigration status. 


Who is NOT Affected

Most immigrants are not affected, says Alvares. People who are exempt include pregnant women, children under 21, people with disabilities and mothers within 60 days after giving birth.

Other programs not subject to Public Charge include:

– Medicaid and health insurance and health services other than support for long-term institutional care.
– WIC, CHIP, SHELTERS, HEADSTART, HUD public housing, foodstamps, Section 8 housing benefits and other non-cash benefits and special-purpose cash benefits that are not intended for income maintenance.

Immigrants applying for citizenship need not worry unless they are planning to leave the country for longer than six months.


How Congress is Responding

Democrat Rep. Judy Chu of California said the Trump administration was ‘on a mission to spread fear and uncertainty among immigrants in the United States.’ The Public Charge was one of ‘a steady stream of anti-immigrant policies’  issued by the White House. Its discriminatory impact has pushed even legal immigrants who have qualified and paid for services to disenroll from these programs, putting families and children at risk for poor health outcomes and living in poverty. Congresswoman Chu has introduced a bill (HR 3222) to prevent any federal dollars from being used to implement the rule, and as Co-Chair of the Congressional Tri-Caucus, also announced that Tri-Caucus leaders have submitted briefs that support litigation opposing the public charge rule  which blatantly discriminates  against immigrants of color.” 


Litigation against Public Charge continues.

Fortunately, says Alvaro Huerta (NILC), the State of Illinois achieved an injunction which is still in effect, that blocks DHS from implementing the new public charge rule there. Lawsuits challenging the rule continue to be filed across the nation in California, New York, Maryland and other districts courts, to determine whether the Trump administration violated the law when it finalized the Public Charge regulation.  Arguments focus on whether the administration failed to consider evidence provided by thousands of commenters on the harm that a racially motivated ruling would cause as it went into effect. 


How to Demystify Public Charge impacts and Fight Back

The key takeaways, says Madison Allen, is to understand who is not affected, which immigrants are most at risk, what programs are exempt and what benefits used by family members are subject to public charge consideration.

Families need to work with community partners and get advice from immigration attorneys to understand how public charge impacts them, cautions Mayra Alvarez. “It is essential that families know their rights”  and find low cost options to get legal assistance.  

Facts Sheets and resources are available at:
www.protectingimmigrantfamilies.org
www.immigrantadvocates.org/legal 
https://www.ilrc.org/public-charge

Meera Kymal is a Contributing Editor at India Currents

 

 

Behind The Troubling Rise Of Uninsured American Kids

More than a million fewer children receive public health insurance now than in December 2017. In some cases, their parents acquired coverage at work. But researchers also see a troubling rise in uninsured children — and say the Trump administration’s policies are partially to blame.

Kaiser Health News senior correspondent Sarah Varney and PBS NewsHour producer Jason Kane report from Tennessee, where the rate of uninsured kids has soared. This story aired on PBS NewsHour on Dec. 2

This article was originally posted by Kaiser Health News.

One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma

Seema Verma, administrator for the Centers for Medicare & Medicaid Services, sat down for a rare one-on-one interview with Kaiser Health News senior correspondent Sarah Varney.

They discussed her views on President Donald Trump’s plan for sustaining public health insurance programs, how the administration would respond if Obamacare is struck down by the courts in the future and her thoughts on how the latest “Medicare for All” proposals would affect innovation and access to care.

A portion of their conversation aired on PBS NewsHour on Dec. 23. A transcript follows, edited for length and clarity.

Verma Attacks Critics Of Medicaid Work Requirement, Pushes For Tighter Eligibility

Seema Verma, the Trump administration’s top Medicaid official, Tuesday sharply attacked critics of her plan to force some Medicaid enrollees to work, a policy that led to thousands of people losing coverage in Arkansas.

“We cannot allow those who prefer the status quo to weaponize the legal system against state innovation,” the administrator of the Centers for Medicare & Medicaid Services said in a fiery speech to the nation’s 56 state and territorial Medicaid directors in Washington, D.C.

federal judge shut down the short-lived work requirement initiative in Arkansas and stopped it from launching in Kentucky last spring. Several states including Indiana, Arizona and New Hampshire that had won federal approval have put their implementation plans on hold pending an appellate court ruling.

Advocates for the poor argue work requirement policies are illegal and unfairly add hurdles to people who qualify for coverage in the federal-state health program.

But those opponents are seeking “to manipulate Medicaid into the prototype of a single-minded, single-payer nirvana – a utopia of open-ended government run health care,” Verma said. “Part of my mission is to fight such under-handed tactics and preserve the right of states to shape your programs in ways that are consistent with the needs of your residents, your cultures and your values. Anything less stifles innovation.”

That would be “a disservice to the millions of people on Medicaid today and those who will need it in the years and decades to come,” she added.

The federal government has approved work requirement plans in 10 states and requests are pending from 10 others. Most of those initiatives are directed at the low-income adults who gained coverage through the Medicaid expansion initiated by the Affordable Care Act.

Verma first announced plans to open the door to work requirements in a speech to Medicaid directors in 2017.

Medicaid – like Medicare – is an open-ended entitlement program, which means federal funding increases as costs and enrollment rise.

In addition to doubling down on the controversial work requirements, Verma renewed her interest in letting states get Medicaid funding through a block grant system. Block grants would give states more flexibility to limit enrollment and enforce eligibility rules, she added.

Critics have said such a change would cut Medicaid funding, limit coverage, hurt beneficiaries and lead to lawsuits.

But Verma said CMS would soon publish guidance to states to allow them to get block grant funding for “certain optional adult populations.”

“Many states have expressed a willingness to be held accountable for improving outcomes in exchange for greater flexibility and budget certainty,” Verma said. “Block grants and per capita cap proposals are two such alternative financing approaches.”

Also Tuesday, CMS issued a proposed rule that would overhaul so-called supplemental payments that many states receive to help their hospitals, nursing homes and doctors get extra funding beyond those received when caring for Medicaid enrollees.

The federal government spent about $48.5 billion on such supplemental payments in 2016 for states.

The payments – as a share of total Medicaid fee-for-service expenditures for health providers – ranged from 1% in North Dakota to 65% in Tennessee, according to a Congressional Research Service report.

CMS and congressional investigators have said the payments allow states to game the system to help bring in additional revenue for these providers without showing how they spend the money.

“I recognize that these schemes often have their roots in self-interested providers, egged on by opportunistic consultants seeking to leverage regulatory loopholes or hide behind a lack of transparency,” Verma said. “I know that most state leaders want to make sure every dollar is supporting value and improving care for Medicaid beneficiaries, and those of you that are doing the right thing have nothing to worry about. We have your back.”

The supplemental Medicaid payment system has come under criticism for many years because of the lack of transparency at the state level. However, efforts to curtail the spending has faced pushback from both states and providers fearful of losing dollars.

Matt Salo, executive director of the National Association of Medicaid Directors, said state officials are open to efforts to bring more transparency but they will be cautious about anything that severely reduces their funding.

“The challenge is how do you do this in a thoughtful, real world way?” Salo said. “We have to do it in a way that is achievable, but that does not jeopardize patient care in the process.”

Verma acknowledged that the uninsured rate among children has grown in the past two years despite the strong economy. She said the solution is to lower health costs to make it easier for their parents to afford private coverage.

Patient advocates have blamed states’ efforts to tighten Medicaid eligibility as a leading factor in the drop in coverage.

Nonetheless, Verma said she would push states to further limit eligibility to make sure only those eligible are getting benefits.

“Lax eligibility practices jeopardize the sustainability of the program,” she said.

CMS will “ensure that states conduct timely redeterminations and make use of appropriate data sources to verify ongoing income eligibility.”

Salo said state Medicaid directors agree with the need for appropriate safeguards to make sure people are not getting assistance who are not eligible. But, he added, forcing enrollees to go through more steps to get and retain coverage will come at a cost of losing people who truly deserve to get help.

“You want government to work for people and want to create a system that if you are eligible it should be easy to get on,” he said. “And if you set barriers and hurdles you will lose a lot of people who are eligible but could not deal with the paperwork.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Can the Public Charge Rule Deny Your Green Card?

A recent Politico survey shows that 80% of Indians who applied for green cards were initially denied by a new Public Charge rule, but were able to reverse the decision and get approval. 

In a national telebriefing Jeanne Batalova from the Migration Policy Institute said 69% of recent green card applications were initially denied because applicants used a public benefit (long-term care benefits or cash assistance), and because cases reviewed at embassies and consulates face stricter guidelines enforced by the Department of State.

But, said Batalova, in 2016, out of 1000 applications that were denied by US consulates abroad, over half were able to reverse decisions and get approved. She suggested that families going through the process abroad should consult experts to create a strategy appropriate to their families.

The new Public Charge rule, introduced by the Trump administration in 2018, was expected to go into effect on October 15. However, In October, five federal courts in New York, Washington & Maryland, temporarily blocked changes that would allow the Dept. of Homeland Security (DHS) to deny green cards and permanent resident visas to immigrants who use Medicaid, food stamps and other government benefits.

Despite court  injunctions temporarily blocking the new rule, confusion about regulations and  anti-immigrant rhetoric has triggered widespread fear among low-income immigrant families who think their receipt of benefits could harm their current or future immigration status. 

“Much of the damage is already done,” said Mayra Alvarez of the Children’s Partnership (LA), with families declining to enroll in Medicaid, SNAP or other public programs they are entitled to. The Kaiser Family Foundation reported declining enrollment in Medicaid coverage, and a Children’s Partnership survey reported increased anxiety among children about  going to school or the park.

Who Is Affected by the Public Charge Rule?

A Public Charge determination applies only if non-immigrant visa applicants or permanent residence seekers have received public benefits like nursing care facility or hospitalization, or general cash assistance like SSI or TANF, said Allison Davenport, an attorney with the Immigrant Legal Resource Center (ILRC).

New criteria added to the list now includes Section 8 Housing, subsidized housing, and food stamps (SNAP) and some forms of  Medicaid.

The DHS will evaluate other factors like age, health, health insurance, job history, education, English skills to determine if an individual could become a public burden, so applicants will need proof of private insurance or make 200 percent of the Federal poverty guidelines.

Those at risk of being denied are persons who have no private health insurance, or who have received 12 months of public benefits listed in the new rule in the 36 months prior to filing their application.

The ILRC co-sponsored a national telebriefing with the National Immigration Law Center and Ethnic Media Services on October 17,  to explain who is affected and how immigrant communities can fight back.

Most Immigrants Are Not Affected

Most undocumented immigrants will not be affected because they are not eligible for these public benefits, said Davenport. They include refugees, asylees, U visa crime victims, T visas human trafficking survivors, and VAWA family violence victims. Special immigrant juveniles ( abused, abandoned and neglected minors) and some people renewing certain forms of temporary protection (DACA, TPS) are also protected. The new regulations also exempt:

Pushback Against Public Charge

More than a quarter million people spoke out against the Public Charge after it was published in Oct 2018, setting a record for the most comments ever submitted to the DHS on any proposed rule.  

Madison Allen, an analyst at the Center for Law and Social Policy, said that respondents shared research, evidence and powerful stories on how the proposal could potentially harm the health, wellbeing and economies of communities across the country, while members of Congress commented that it was inappropriate for the DHS to override Congressional intent.

A Policy of Exclusion in Search of a Justification

These public comments laid the groundwork for litigation and were central to the nationwide preliminary injunctions the courts issued to block the Public Charge anywhere in the U.S. Judges also mentioned the failure of the administration to take comments into account, the “extreme overreach” of the proposal and its apparent violation of congressional intent. 

Judge George Daniels of the Southern District of New York called the rule “A policy of exclusion in search of a justification.” 

What People Should Do

Alvarez urged families to stay enrolled in their benefits as changes cannot move forward while preliminary injunctions are in place. They should consult immigration attorneys and local non-profits for legal advice on how the new rule will affect their particular case.

The 1999 policy guidelines that remain in effect make it clear that housing, health and nutrition programs cannot be considered in the Public Charge determination, and, it will take months before another interim court rules on the case as it winds its way to the Supreme Court.

A directory of resources is available at  www.immigrantadvocates,org/legal 

Meera Kymal is a Contributing Editor at India Currents