National Senior Citizens Law Center: Interview With Paul Nathanson

Protecting the Rights of Low-Income Seniors
Nationl Senior Citizens Law Center PaulNathanson
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Low-income older adults in the U.S. number into the millions, if not tens of millions, depending on how poverty is measured. These older adults require healthcare, housing, and living assistance but often find themselves at the mercy of a complicated system which they have neither the means nor the knowledge to successfully navigate. Paul Nathanson is the executive director of the National Senior Citizens Law Center.

Tell us about the NSCLC.

Paul Nathanson: The National Senior Citizens Law Center is a nonprofit advocacy organization that protects the rights of low-income older adults. Our priority issue areas are healthcare and economic security. We use advocacy, litigation, and the education and counseling of local advocates to achieve our objectives.

What should low-income older adults, and those who care for them, be particularly aware of in terms of their legal rights to healthcare services such as Medicare and Medicaid?

PN: Increasingly, government health programs such as Medicare and Medicaid seek to save money and create more efficiency by moving thousands of low-income older adults into managed care. Navigating a managed care system can be difficult for people. NSCLC is currently working to make sure that individuals are not denied care or benefits as these programs expand and that states establish an adequate system of consumer advocates who can help individuals who are having problems getting the care they need.

What options are available for those low-income older adults who feel they have been unfairly or perhaps illegally denied adequate healthcare or other services?

PN: There are rights to appeal the loss of benefits or denials of benefits, and it is important for people to read denial letters from insurance companies or government programs carefully so they can keep track of deadlines in order to preserve their rights. Local legal services organizations are good sources of assistance for people with limited resources who need help with appeals. However, sometimes appeal rights are denied because of bureaucratic barriers. We are currently working on fixing the broken Supplemental Security Income (SSI) nondisability appeals process. Far too often, when someone files an appeal with the Social Security Administration, the paperwork is routinely lost or not acted upon. Sometimes, a person's right to a hearing is denied.

Another problem is that many government programs do not translate critical documents into languages other than English. For the millions of Americans with limited proficiency in English, this can create an overwhelming challenge in getting benefits to which they are entitled. Even when some help is available, such as telephone interpreters, it is not always adequately publicized so individuals do not know that they can get assistance. We work with federal and state agencies to address these issues.

Regarding the Affordable Care Act, what is the NSCLC both most pleased and concerned about as it relates to low-income older adults?

PN: The expansion of access to healthcare to so many people who currently are uninsured, including especially the expansion of Medicaid coverage to previously uncovered adults, is of course the most important part of health reform and has a huge impact on people in their 50s and 60s, so many of whom have preexisting conditions that made health insurance unaffordable. It means that many people, when they qualify for Medicare, will come to the program healthier and with their chronic conditions under control. But there also are many less-publicized provisions of the Affordable Care Act that directly affect Medicare and Medicaid benefits for older adults. Lower drug costs and the eventual closing of the "doughnut hole" for Medicare Part D prescription drugs is hugely important for individuals with high drug costs. Also important are many provisions aimed at "rebalancing" long-term care so that more individuals can get the care they need at home and in the community, rather than having to go to a nursing home.

We are concerned about the details of implementation of changes that the Affordable Care Act makes possible. For example, large demonstration projects will be moving as many as two million dual eligibles -- people who qualify for both Medicare and Medicaid -- into managed care plans for all their health needs. Many states also are in the process of moving all their Medicaid programs into managed care. Although these programs offer the promise of coordination of care, they will only be good for low-income older adults if they are implemented in a way that offers strong consumer protections.

In what ways are those people who are dual-eligible (eligible for both Medicare and Medicaid) at risk as healthcare reform laws are put in place?

PN: Our concerns and those shared by advocates for dual eligibles across the country have to do with protecting dual eligibles as they are moved into private managed care plans. Making sure that the networks that the managed care plans use are adequate for the complex needs of these consumers is a big issue. Having enough specialists is important, but so is being able to get personal care services so you can stay at home safely. And, definitely, dual eligibles need an appeals process that is easily understood and recognizes their due process rights.

What does the NSCLC advocate in terms of home- and community-based long-term services and supports for low-income older adults?

PN: There is much that needs to be done to correct the existing institutional imbalance in Medicaid. Far too many people who would rather live in the community are forced to go to nursing homes because their state's Medicaid program will not pay for the long-term services and supports they need to stay at home. NSCLC is advocating for expansion of home and community-based services and also for appropriate regulation to ensure the quality of those services. NSCLC advocates for broader Medicaid coverage for home and community-based services so that people can remain independent as long as possible.

Lastly, how can people get involved with the NSCLC?

PN: NSCLC has both a health network and an income network for advocates in legal or aging services who are interested in issues affecting low-income older adults. Advocates can sign up for free alerts and a newsletter on our website,

Brad Prescott

Based in San Francisco, Brad Prescott is a Senior Editor for Caring. See full bio