Supplemental Nutrition Assistance Program (SNAP): Eligibility,

This proposed rule would implement provisions of the Food, Conservation and Energy Act of 2008 (FCEA) affecting the eligibility, benefits, certification, and employment and training (E&T) requirements for applicant or participant households in the Supplemental Nutrition Assistance Program (SNAP). The rule would amend the SNAP regulations to:

• Exclude military combat pay from the income of SNAP households;
• raise the minimum standard deduction and the minimum benefit for small households;
• eliminate the cap on the deduction for dependent care expenses;
• index resource limits to inflation;
• exclude retirement and education accounts from countable resources;
• permit States to expand the use of simplified reporting; permit States to provide transitional benefits to households leaving State-funded cash assistance programs;
• allow States to establish telephonic signature systems;
• permit States to use E&T funds to provide post-employment job retention services; and
• limit the E&T funding cycle to 15 months.

These provisions are intended to increase SNAP benefit levels for certain participants, reduce barriers to participation, and promote efficiency in the administration of the program.

DATES: Comments must be received on or before July 5, 2011.

Full Federal Register Notice

stevegoldada: Attacking Medicaid - Myths and Some Realities.

By Steve Gold 

Aldttacking Medicaid - Myths and Some Realities. Information Bulletin # 320 (4/2011)

There have been a lot of articles and speeches attacking Medicaid: “GOP Governors Seek Leeway to Cut Medicaid,” “Fiscal Health Hinges on Containing Costs of Care.”

Now comes Rep. Ron Paul plan to change Medicaid.....

From article to article to political speech, the drum beat is the same: “Block Grant” Medicaid so states can set their own rules and achieve, hear the drum roll, “flexibility.”

Block grants are allocate federal funds based on the total number of people or the number of low-income people, or some other criteria. Under block grants, States would decide who will be eligible and which “medically necessary” conditions to cover. States would receive a dollar grant to spend as they wish. If you think politicians, lobbyists, and pressure groups are active now, just wait if there are block grants and no federal standards or requirements.

There are a number of reasons for the current activity.

First and probably the most important reason, this is a backdoor attack against the 2010 Health Care Reform Act. Last year, Congress, for the first time in our history, enacted that all low-income people - below 133% of the poverty level - will be eligible for Medicaid in 2014. That’s an addition 16 million low-income Americans.

In the past, Medicaid eligibility was federally based primarily on categories, so that two people with the same income but different sources of income were treated differently. The Health Care Reform Act ensures that two people in the same or different states with the same income and same impairments will not be treated differently.

When you hear Medicaid Block Grants, think “eligibility.” As David Wessel wrote in the Wall Street Journal, “The argument is that with ‘flexibility,’ states can do more with less. But the biggest ‘flexibility’ that states now lack - given that many already rely heavily on managed care and low provider fees - is the authority to reduce the rolls. That leaves them to do less with less.”

What’s fascinating about this conservative attack is that they do not articulate who currently on Medicaid does not need or does not “deserve” to receive health care. What’s at stake is the answer to the question “If a low-income American needs health care, should they receive it?”

Second, States presently have a lot of authority to control their Medicaid costs. Medicaid costs can be contained under the present system, but it does take some political backbone. Despite the drum roll of “out of control” Medicaid costs, these costs can be and have been in some instances controlled. For example, between 2000 and 2005, Medicaid reimbursements for drugs increased by 95.9%. To counter that, States took control and by 2009, reduced Medicaid’s drugs expenditures by 44%.

Another example of States controlling Medicaid costs should focus on why 17.4% of all Medicaid nationally in FY 2009 went to keep people with disabilities institutionalized. States control this. Yes, States throughout the country spent more on nursing homes and institutions for persons with development disabilities than they spent on in-patient hospitalization and drugs! The federal government did not make States do this. Medicaid did not make the States do this! Moreover, many of these institutions provide at most custodial care; they’re the 21st century’s poorhouses and homeless shelters paid for by Medicaid.

Again, as David Wessel wrote in another column, regarding “often overlooked facts.... Medicaid pays 43% of America’s long-term care bill, including bills for about 60% of nursing-home residents.” He correctly points out that right now, without any changes in Medicaid, States could “keep the elderly and disabled out of nursing homes by helping them pay for home or community-based care... It’s cheaper and often preferred by the individual. That push has been under way for years. It’s now at risk as states scramble to save money, and eye cuts to home and community-based care.”

Cheaper, preferred? Why is it not happening? States control this and have decided to buckle under to the nursing home lobby! Ask your State’s nursing home lobby how much they contributed to your Governor’s campaign. It’s not the present Medicaid statute.

Third, presently States pay with State general revenue funds at most 50% of Medicaid costs, and the federal government matches States expenditures. About 36 states receive more than 50% from the federal government depending on the state’s per capita income. The poorer the State the more federal match. Don’t be fooled that the push for “Block Grants” is to help States financial situation. The feds pay an enormous share of Medicaid.

Right now, the Medicaid standard is that only “medically necessary” services and treatment are required. Let the Block Grant proponents identify and list which specific “medically necessary” services should not be paid for.

It’s critical that advocates for disabled older and younger Americans get into the fray. Our lives and the lives of brothers, sisters, neighbors, friends and all low-income people depend on it.

stevegoldada: Attacking Medicaid - Myths and Some Realities.

Extenuating Circumstances When Screening Applicants with Disabilities

by Steve Gold

HUD states "it has recently come to the attention" of HUD that people with disabilities"face additional challenges during screening procedures [for public housing and housing choice vouchers] due to poor credit histories often exacerbated by outstanding medical costs related to their disability."

Disability advocates have been aware of this for many years so we're  delighted that HUD also now knows about it.

HUD's letter reminds PHAs that "discretion can and should be applied when  determining admissions and occupancy policies."  It further states that  HUD "encourages PHAs to consider extenuating circumstances when screening  applicants with disabilities."

While HUD's "reminder" is very welcomed, disability advocates should  remember that under the disability laws b 504, Fair Housing Act, and ADA,reasonable accommodations and reasonable modifications of policies are  mandatory. The failure to consider the above "extenuating circumstances"  as a basis for a   reasonable accommodation  for a person with a disability   is a   civil rights violation!  A policy that blocks such accommodation is   also a violation.

The "poor credit history" is only one barrier.   Other barriers have also   prevented   people with disabilities   from receiving federal   housing benefits  - past criminal histories, especially pre-disability; needed extra rooms   for   durable medical equipment   or for live-in personal assistants;   mandatory inclusion of costs for meals in 202/811s.  We strongly recommend   that the reasonable accommodation route be used for all of these barriers.

While the above HUD memo was written by an   Assistant Secretary   for  Public Housing, the same     proscriptions apply to all federally funded  housing and to other housing subject to the Fair Housing Act.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.

Information Bulletins are also posted on my blog located at  http://stevegoldada.blogspot.com/

Legal Services Corporation Eligibility Rule Change

The Legal Services Corporation (‘‘Corporation’’) is required by law to establish maximum income levels for individuals eligible for legal assistance. This document updates the specified income levels to reflect the annual amendments to the Federal Poverty Guidelines as issued by the Department of Health and Human Services.

Effective Date: This rule is effective as of January 31, 2011.
Complete Federal Register Notice

H.R. 186: To amend title 10, United States Code, to expand the eligibility for concurrent receipt of... (GovTrack.us)

To amend title 10, United States Code, to expand the eligibility for concurrent receipt of military retired pay and veterans' disability compensation to include all members of the uniformed services who are retired under chapter 61 of such title for disability, regardless of the members' disability rating percentage.

Sponsor:	Rep. Addison Wilson [R-SC2](no cosponsors) Cosponsors:
Text:	The text of this legislation is not yet available on GovTrack. It may not have been made available by the Government Printing Office yet.
Status:	Introduced Jan 5, 2011 Referred to Committee View Committee Assignments Reported by Committee ... House Vote ... Senate Vote ... Signed by President ... This bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: Jan 6, 2011 11:35AM]
Last Action:	Jan 5, 2011: Referred to House Veterans' Affairs

Current Status

Health Option for Poor Used by Well-Off New Yorkers - NYTimes.com

Image via CrunchBaseBy ANEMONA HARTOCOLLIS

AFTER immigrating to New York City from China in the 1970s, Z. Y. Tung and his wife worked hard — he as a bank manager, she as a public school secretary — lived frugally and saved every penny they could for the next generation. 

Until five years ago, when his wife, Wen Mei Hu, racked by bone-marrow cancer, had to be put in a nursing home, where the bills ran past $100,000 a year, threatening to quickly drain the couple’s life savings of $500,000. The nursing home told him not to worry: If he signed a document essentially refusing to support his wife of several decades, Medicaid, the federal insurance program for the indigent, would pick up the bill.

“What about me, because I am responsible?” Mr. Tung inquired. He was told that only millionaires had to pay such high costs, and reluctantly, seeing no other choice, he agreed.
Full Article

Medicare Coverage Standards Are Too Strict, Courts Find - NYTimes.com

Image via CrunchBaseby Robert Pear
Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older
Americans are entitled to Medicare coverage of skilled nursing home care and home health care.

Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said.

Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.

The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer’s disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person’s condition is stable and unlikely to improve, the courts said.
Full Article

Jobless are straining Social Security's disability benefits program

Image via WikipediaBy Michael A. Fletcher Washington Post Staff Writer

The number of former workers seeking Social Security disability benefits has spiked with the nation's economic problems, heightening concern that the jobless are expanding the program beyond its intended purpose of aiding the disabled.

Applications to the program soared by 21 percent, to 2.8 million, from 2008 to 2009, as the economy was seriously faltering.

The growth is the sharpest in the 54-year history of the program.
Full Article

The Truth About Gays, Lesbians, and Social Security Benefits

Thank You For Your Call from Shawn Nee / discarted on Vimeo.

NCOA Offers Two New Tools for Seniors in Need of Benefits

The National Council on Aging’s National Center for Benefits Outreach & Enrollment (NCBOE) has developed a new data mapping tool that allows users to search for information about eligibility and enrollment trends in Medicare and Medicaid benefits programs. The map also provides statistics on the number of individuals eligible for or enrolled in programs such as Medicare Part D Extra Help.

For guidance on how to navigate the map, please go to http://ssl4.benefitscheckup.org/datamap/

NCBOE also has published a new issue brief called Extra Help to Keep Extra Help: Assisting LIS Beneficiaries Who Lose Their Deemed Status. It offers promising strategies using list-driven communications to help beneficiaries adversely affected by the redeeming process regain and retain the Medicare Part D Low-Income Subsidy.

To download a copy of the http://www.centerforbenefits.org/NCBOE%20Issue%20Brief%206.pdf

To learn more about the National Council on Aging’s National Center for Benefits Outreach & Enrollment, please go to http://www.ncoa.org/

Income Level for Individuals Eligible for Legal Services Corporation Assistance

The Legal Services Corporation (``Corporation'') is required by law to establish maximum income levels for individuals eligible for legal assistance. This document updates the specified income levels to reflect the annual amendments to the Federal Poverty Guidelines as issued by the Department of Health and Human Services.

Effective Date: This rule is effective as of August 6, 2010.

Final Rule

H.R. 3787: To amend title 38, United States Code, to deem certain service in the reserve components as... (GovTrack.us)

Image by maphu via Flickr

To amend title 38, United States Code, to deem certain service in the reserve components as active service for purposes of laws administered by the Secretary of Veterans Affairs.

Sponsor: Rep. Timothy Walz [D-MN1]

Cosponsors: John Adler [D-NJ3],Brian Bilbray [R-CA50], John Boozman [R-AR3], Paul Broun [R-GA10], Henry Brown [R-SC1],Gerald Connolly [D-VA11], Joe Courtney [D-CT2], Bob Filner [D-CA51], Charles Gonzalez [D-TX20], John Hall [D-NY19], Deborah Halvorson [D-IL11], Phil Hare [D-IL17], Stephanie Herseth Sandlin [D-SD], Thomas Latham [R-IA4], Eric Massa [D-NY29], Jerry McNerney [D-CA11], Michael Michaud [D-ME2], Harry Mitchell [D-AZ5], James Oberstar [D-MN8], Solomon Ortiz [D-TX27], Thomas Perriello [D-VA5], Collin Peterson [D-MN7], Earl Pomeroy [D-ND], Ciro Rodriguez [D-TX23], Phil Roe [R-TN1], Gene Taylor [D-MS4], Harry Teague [D-NM2]

Full Text

Status:
Introduced Oct 8, 2009
Referred to Committee on Veterans Affairs
Read More

Updated Information

SSA: Revision of Medicare Part D Forms

Request for Comments The information collections below are pending at SSA. SSA will submit them to OMB within 60 days from the date of this notice. Therefore, your comments would be most helpful if you submit them to SSA within 60 days from the date of this publication. Individuals can obtain copies of these collection instruments by calling the SSA Reports Clearance Officer at 410-965-0454 or by writing to the e-mail address listed above. 1. Application for EXTRA Help with Medicare Prescription Drug Plan Costs--20 CFR 418.3101--0960-0696. The Medicare Modernization Act of 2003 mandated the creation of the Medicare Part D prescription drug coverage program and provided for certain subsidies for eligible Medicare beneficiaries to help pay for the costs of prescription drugs. SSA uses Form SSA-1020 (and the i1020, its electronic counterpart), the Application for Extra Help with Medicare Prescription Drug Plan Costs, to collect information to make Part D subsidy eligibility determinations. In compliance with Public Law 110-275, beginning in January 2010, SSA will use a new version of Form SSA-1020. In this new version, SSA will eliminate questions about the value of life insurance policies and in-kind support and maintenance, and we will ask applicants about their interest in applying for the Medicare Savings Program. This information collection request (ICR) is for the new version we will use in 2010. The respondents are Medicare beneficiaries who are applying for the Medicare Part D subsidy. 2. Medicare Subsidy Quality Review Forms--20 CFR 418(b)(5)--0960-0707. The Medicare Modernization Act of 2003 mandated the creation of the Medicare Part D prescription drug coverage program and provided for certain subsidies for eligible Medicare beneficiaries to help pay for the costs of prescription drugs. As part of its stewardship duties of the Medicare Part D subsidy program, SSA must conduct periodic quality review checks of the information Medicare beneficiaries report on their subsidy applications (Form SSA-1020). SSA uses the Medicare Quality Review program to conduct these checks. Beginning in January 2010, SSA will revise the Medicare Quality Review system to comply with Public Law 110-275. Specifically, we will: (1) Eliminate the use of Form SSA-9309, the Life Insurance Verification form; and (2) remove any questions about life insurance policy values and in-kind support and maintenance from the other forms in the collection. This ICR is for the revised Medicare Quality Review System, which we will not use until January 2010. The respondents are applicants for the Medicare Part D subsidy whom we have chosen to undergo a Quality Review. 3. Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs--0960-0723. As required by the Medicare Modernization Act of 2003 (Pub. L. 108-173), SSA conducts low-income subsidy eligibility redeterminations for Medicare beneficiaries who filed for the subsidy and were determined by SSA to be eligible. SSA will conduct subsidy eligibility redeterminations under two circumstances: (1) When an individual completes Form SSA-1026-OCR-SM-SCE to report a subsidy-changing event (marriage, separation from a spouse, separated spouses resume living together, divorce, annulment, or death); and (2) When SSA uses Form SSA-1026-OCR-SM-REDE to conduct an annual review of individuals who became entitled during the prior 12 months, an annual review of a percentage of individuals who are eligible for more than 12 months, and a review of individuals who report a change in income, resources, or household size that may affect the subsidy amount. In compliance with Public Law 110-275, SSA will use a new version of Form SSA-1026 beginning in January 2010. In this new version, SSA will eliminate questions about the value of life insurance policies and in-kind support and maintenance. The respondents are current recipients of the Medicare Part D low-income subsidy who will undergo an eligibility redetermination for one of the reasons mentioned above.

SSDI: Collection of Medical Evidence Could Be Improved

What GAO Found Obtaining timely and complete medical records is a challenge to DDSs in promptly deciding disability claims, and DDSs have responded with additional provider contacts and adjustments to their payment procedures. Although DDSs pay most medical providers for medical records and SSA pays the DDSs to cover these expenses, 14 of 51 DDSs reported the percentage of requests for which they did not receive records was 20 percent or more in fiscal year 2007. In response to this challenge, all DDSs conduct follow-up with providers and claimants to urge them to provide records. Over half of the DDSs (34 of 51) have also implemented more timely payments for records and six increased the amount they pay. Although SSA evaluates DDS collection of medical records, it does not compile key data necessary to identify and share promising collection practices. SSA has made progress moving to electronic collection of medical records, but faces challenges in fully implementing electronic retrieval and analysis of medical evidence. SSA now uses electronic images instead of paper copies of new claimants' records. Though SSA seeks to obtain all records electronically and provides options for online submission of records, only one large provider accounts for most of the records submitted online, and about half of all records received are on paper. To date, SSA has taken only limited action to identify and analyze the barriers providers face in using current electronic record submission options, and has not developed a strategy to address them. In the long run, SSA is participating in an advanced prototype to collect medical records in formats that can be searched and analyzed by electronically querying a hospital’s records database and directly retrieving the claimants’ records. What GAO Recommends GAO recommends SSA identify DDS evidence collection practices that may be promising, evaluate their effectiveness, and encourage implementation of successful practices in other states, as applicable. To do so, SSA should cost-effectively compile and assess additional data on the collection process. SSA should also work to identify and address barriers to expanded use of its online medical evidence submission options.

Home and Community Based Waivers and Self Employment – fact sheet

Summary Medicaid waivers funds can be used to support self-employment, but may not be used directly to fund the development of a business. This factsheet provides answers to questions about how to leverage waivers supports for self-employment while complying with these regulations. It also outlines eligibility requirements and presents short case studies. Author Sullivan, Molly; Katz, Marsha Available Files Fact Sheet PDF (23K, 7 pages) Fact Sheet Word (65K, 9 pages)

Exam for Housebound Status or Permanent Need for Regular Aid and Attendance

VA will use VA Form 21-2680 to gather medical information that is necessary to determine beneficiaries or claimants receiving treatment from private doctors or physicians, eligibility for aid and attendance or housebound benefit.

GAO Report: Medicare Part D Low-income Subsidy

This report focuses on beneficiaries’ access to prescription drugs by examining (1) the importance of assets and income in LIS denials in 2006 and 2007, and (2) state and manufacturer programs providing access to prescription drugs for Medicare beneficiaries. The report shows that in 2006 and 2007 income was a more important factor in LIS denials than assets, but both were important. Whether or not there should be an asset test in addition to the income test is an issue that cannot be resolved by analysis. Those beneficiaries who do not qualify for the LIS because their assets are above the program threshold, but whose incomes are limited, may obtain access to drugs through 23 state programs and through drug manufacturer programs. However, the availability of these programs and the assistance they offer are uneven, and they do not provide the coverage obtained through a national program with uniform eligibility standards.