It's all too common to see provider groups competing with one another for Medicare dollars in Washington, especially after the sweeping cuts included in the 1997 budget law.
Specialty physicians battle primary-care physicians. Small rural hospitals duel their large urban counterparts. And now low-income beneficiaries are vying with poor children not only for healthcare funding but for HCFA's attention.
That new twist on an old scenario is revealed in a class-action lawsuit filed by four state-based senior advocacy groups last week in U.S. District Court in Washington.
The Texas Gray Panthers, the Action Alliance of Senior Citizens of Greater Philadelphia, the Massachusetts Association of Older Americans and the New York Statewide Senior Action Council allege that HHS and the Social Security Administration failed to inform beneficiaries about and enroll them in special "buy-in" programs.
The five programs, passed by Congress at different times over the past 10 years, allow low-income seniors to sign up for relief from Medicare premiums and other costs by enrolling in Medicaid and adjusting their Social Security income.
In addition, Congress required HHS to establish an advisory program to help eligible seniors enroll in the buy-in programs.
The lawsuit alleges that HHS, through HCFA, has neglected to provide clear information on the programs to the 4.5 million beneficiaries who are eligible but not receiving assistance and counseling.
"Unless these individuals learn about the program and enroll in it, they will continue to suffer serious injury, despite their eligibility," the plaintiffs charged in the suit.
The groups sought legal action after a decade of lobbying for changes failed to get results.
Advocates for the elderly said part of the problem is that HCFA has put too much energy into getting children signed up for the Children's Health Insurance Program. CHIP allocates $24 billion over five years to be used to purchase health insurance for low-income uninsured children who aren't eligible for Medicaid.
CHIP was passed as part of the Balanced Budget Act of 1997-the same law that restricted Medicare payments for nearly all services used by the elderly, including hospital care and nursing homes.
"HCFA has done a very minimal job as far as getting the word out to seniors about these Medicare assistance programs," said Patricia Nemore, a spokeswoman for the National Senior Citizens Law Center in Washington, which is working for the plaintiffs. "They've given lots of attention to low-income children, but there's no comparable attention being given to this group of seniors."
In fact, just last week a bipartisan group of senators introduced a bill that would allow children of legal immigrants to sign up for health insurance through Medicaid and CHIP.
A HCFA spokesman said the agency does not comment on pending litigation.