The proposed rule from the Centers for Medicare & Medicaid Services (CMS) is in response to a federal court ruling that affects Medicare beneficiaries who received “observation services” in a hospital as outpatients.  The case of Alexander v. Azar in the U.S. District Court of Connecticut was decided by a federal judge in March 2020 and requires that beneficiaries who are initially admitted as hospital inpatients, but are subsequently reclassified as outpatients (resulting in a denial of coverage for the hospital stay under Medicare Part A), are entitled to an appeals process if they meet other eligibility criteria. CMS is requesting comment from the public on this proposal to create a standardized notice advising beneficiaries of their rights to three types of appeal – expedited, standard, or retrospective – depending on the patient’s current status.

Comment by February 22

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In compliance with the Inflation Reduction Act, the Centers for Medicare & Medicaid Services’ Low-Income Subsidy Program (also known as Extra Help) will provide full financial assistance to beneficiaries enrolled in the Medicare Part D program with incomes up to 150% of the federal poverty level. Medicare beneficiaries who are eligible and enroll in Medicare Savings Programs are automatically eligible for full low-income subsidies, the payment of Medicare Parts A and B premiums, and cost-sharing. Other Medicare beneficiaries must apply for the Extra Help program via the Social Security Administration to obtain these subsidies.

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The plan sets the stage for structural changes – from the federal to state and community levels, both inside and outside of government – that are meant to address the social needs affecting health outcomes and hindering health equity.  Three pillars would form the initial scaffolding for a nationwide effort: 1) data gathering and sharing; 2) flexible funding for social needs; and 3) support for community-based organizations. Among the federal-level contributions is a collaboration between the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation that began in 2015.  PLACES – Population-level Analysis and Community Estimates of Health – is the first initiative to connect county, place, and Census tract data with the CDC’s surveillance data to develop and implement targeted preventions.

Read the full plan here.

In October, the number of Pennsylvanians enrolled in the food stamp program topped 2 million for the first time even as the state reported record unemployment. The number of people receiving Supplement Nutritional Assistance Program benefits in October stood at 2,016,298 in October, according to data posted on the state’s open data website. The state’s unemployment rate in November remained at 3.4%, the lowest it’s been since at least the 1970s. The number of people enrolled in SNAP in Pennsylvania has been relatively stable for the last decade, but it’s begun to tick up since the pandemic. The number of people receiving SNAP benefits increased 4.4% from September 2022 to September 2023.

An NPR story noted that workforce shortages stir labor unrest. The story focused on how community health centers are the medical safety net of last resort, serving the uninsured, the underinsured, and other vulnerable people. NPR noted that there are more than 1,400 community health centers nationwide, and 67% of them lost between 5% and 25% of their workforce during a six-month period in 2022, according to a report by the National Association of Community Health Centers. Read the story.

Pennsylvanians now have a one-stop webpage to access all of Pennsylvania’s health insurance options. www.pa.gov/Healthcare provides links to:

• Pennie, Pennsylvania’s Health Insurance Marketplace
• The Department of Human Services COMPASS website for Medicaid and CHIP Enrollment
• Department of Aging’s webpage for access to Medicare and PA MEDI
• And the United States Department of Veteran’s Affairs for VA Benefits

This is part of the Commonwealth of Pennsylvania’s guide to needed human service resources including mental health, employment, and personal services.

The Centers for Medicare and Medicaid Services (CMS) Low-Income Subsidy (LIS) Program (also known as Extra Help) provides premium and cost-sharing assistance for low-income Medicare beneficiaries enrolled in Medicare Part D. The way this program operates will change with the new year.

• Currently: Medicare beneficiaries with income up to 135% of the federal poverty level (FPL) receive full financial assistance. Those with an income between 135% and 150% of the FPL receive partial financial assistance.
• On and after January 1: The Inflation Reduction Act (IRA) expands the full financial assistance to Medicare beneficiaries with income up to 150% of the FPL. Medicare beneficiaries who are eligible and enroll in the Medicare Savings Programs (MSP) are automatically eligible for the full LIS subsidies. Other Medicare beneficiaries have to apply via the Social Security Administration to obtain the extra help subsidies.

Providers are encouraged to assist their Medicare patients in applying for MSP coverage. Enrollment in an MSP automatically makes them eligible for full Part D LIS subsidies and the payment of Medicare Parts A and B premiums and cost-sharing.

The Consolidated Appropriations Act requires all states to provide 12-month continuous eligibility to children under age 19 in Medicaid and the Children’s Health Insurance Program (CHIP) beginning Jan. 1, 2024. “Continuous eligibility” means that an enrollee can keep their coverage for 12 months after their eligibility determination (or redetermination) regardless of changes in household circumstances, like income fluctuations. Continuous eligibility helps improve health outcomes and is associated with improved coverage rates, reductions in gaps in coverage, a lower probability of being in fair or poor health, and an increase in the average length of enrollment. While half of states already provided 12-month continuous eligibility for children enrolled in Medicaid or CHIP prior to Jan. 1, 2024, this policy will help ensure that millions more children in Medicaid or CHIP receive the benefits of yearlong periods of uninterrupted coverage.