The Covid pandemic has presented older Americans with plenty of grim news, from staffing shortages in long-term care and hospices to the punishing effects of loneliness and isolation. But there have been encouraging developments too — the kind of incremental progress that can take years to achieve, as lawsuits wend their way through courts, bills die in state legislatures and rise again, and the pandemic complicates everything.
The results are not always dramatic, but they can improve lives and health for older people, especially those with low income. Here are three.
A New Right to Appeal Medicare Decisions
First, a federal appellate court recently ruled that if Medicare declines to pay for your rehabilitation in a nursing home after you’ve left the hospital, because you were “on observation,” you can appeal the decision.
This issue has boggled patients and families for years. You were in a hospital bed, doctors and nurses provided care, you were examined and perhaps received medication, but you were not actually admitted. Or you were, and then the hospital changed your status to “on observation.” Technically you were an outpatient, not an inpatient.
But Medicare requires three consecutive days as an inpatient for you to be eligible for nursing home coverage. So you are left either having to pay the tab yourself (the national average nursing home cost is $260 a day) or forgoing care. In fact, if you are among the 9 percent of Medicare beneficiaries who don’t have Part B, which covers outpatient care, you must pay the hospital bill, too.
Hundreds of thousands of patients discharged from hospitals have probably faced this conundrum. “You can appeal just about every issue regarding your Medicare coverage, but not that one,” said Alice Bers, litigation director at the Center for Medicare Advocacy.
To change this, the center — along with Justice in Aging and a private law firm — sued the federal Department of Health and Human Services in 2011.
Last month, the U.S. Court of Appeals for the Second Circuit affirmed that Medicare beneficiaries have a constitutional right to appeal if hospitals reclassify them as observation patients. If patients win their appeals, traditional Medicare will pay for up to 100 days of nursing home care, and those who were previously forced to pay out-of-pocket could receive refunds. (Medicare Advantage plans don’t generally require the three-day stay.)
The Center for Medicare Advocacy answers frequent questions here.
One catch: The government could still ask the Supreme Court to take the case, or seek a rehearing by the Second Circuit court. And the Medicare appeals process is no picnic. “People have the best chance of winning if they persist and work their way up through the levels,” Ms. Bers said.
Repealing the three-day requirement would take Congressional action. But at least with the right to appeal, you have a fighting chance.
California Eases Medicaid Qualifications
In a second promising development, California is eliminating asset limits for older people who are trying to qualify for Medicaid, and other states are considering similar moves.
Medicaid, the state and federal program that provides health care for the poor and for people with disabilities, and also pays for long-term care in nursing homes and at home, sets strict ceilings on recipients’ wealth. In most states, if you are older than 65, you can amass no more than $2,000 in assets, or $3,000 for a couple (usually with a home and a car exempted).
“It makes people live in very deep poverty,” unable to save for emergencies or even modest expenditures, said Amber Christ, director of health care policy and advocacy for Justice in Aging. “If you go over the limit by a dollar, you lose eligibility.”
California will abolish this ceiling in two steps. In July, the asset limit rises to $130,000 for an individual and another $65,000 for each family member. In July 2024, the state will discard asset limits altogether. If you are older or disabled, you will qualify for Medi-Cal (as California calls its Medicaid program) if your income does not exceed 138 percent of the federal poverty level. The state estimates that about 17,000 residents will become newly eligible.
Gov. Kathy Hochul of New York has incorporated a similar measure in her proposed state budget, eliminating asset limits as of Jan. 1, 2023; the state legislature will tackle the budget in March. Arizona eliminated asset limits in 2001, although not for long-term care, and other states are looking into the approach, Ms. Christ said.
One catch: This year, 138 percent of the federal poverty level amounts to an annual income of $17,774. Medi-Cal recipients must still be poor, but less poor than before, and will be better able to hold onto their health coverage.
Social Security Offices to Reopen
In a third piece of a good news, the Social Security Administration has finally announced that it will soon reopen its 1,200 local offices.
Except for limited “dire need” appointments made at the discretion of managers, offices have remained closed since the pandemic hit in March of 2020. Now, said Mark Hinkle, a spokesman for the agency, “we anticipate that local field offices will restore increased in-person service to the public, without an appointment, in early April.”
This matters. “There are things that have to be done in person for Social Security,” said Kate Lang, senior staff attorney at Justice in Aging. You can apply online for retirement benefits but not for survivors’ benefits or for Supplemental Security Income, or S.S.I., which helps support seniors with very low income.
These in-person requirements have meant that hundreds of thousands of applicants who would normally walk into local Social Security offices, carrying the required original documents, have been out of luck for two years.
Moreover, “people already on benefits have gotten notices saying their benefits are being reduced or discontinued, and they’re unable to get in touch with anyone at Social Security to find out what’s going on,” Ms. Lang said. “There’s no way to fix these problems.”
Trying to reach Social Security by phone can be an exercise in frustration. A report from the agency’s inspector general found that monthly calls to field offices rose from 4.6 million before the pandemic to 7.5 million in April through September 2020, and to 12 million in March of 2021. If you called field offices or the national 1-800 number, you often encountered busy signals or long waits; many callers abandoned the effort.
Even after the Social Security Administration agreed to reopen offices, protracted negotiations with its uneasy employees followed. But the agency and its unions have reached agreements, although they are still working out the logistics of reopening.
One catch: Visitors to a field office will likely face occupancy limits, and the agency must cope with huge backlogs. In an email, Mr. Hinkle said that the agency encourages the public to use its online or phone services when possible and to schedule in-person appointments in advance.
Ms. Lang noted: “It’s not like everything will be hunky dory on April 1.” In fact, Justice in Aging has brought a class-action suit against the Social Security Administration on behalf of S.S.I. recipients who were unable to provide information or challenge decisions while offices were shuttered.
But, Mr. Hinkle said, offices will reopen this spring “dependent on the course of the pandemic” — indisputably a good thing.
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