Since 1990 the Connecticut Department of Social Services (DSS) has contracted with the Center for Medicare Advocacy, Inc. (the Center) to pursue Medicare appeals for home health care services previously paid for by Medicaid on behalf of individuals who are eligible for both Medicare and Medicaid. More than $70 million has already been recovered for the State from the federal Medicare program as a result of this project.

In December, 2002, a settlement agreement was reached with the federal government which is expected to bring $33.3 million in federal revenue to the State this fiscal year for Medicare claims filed by the Center for Medicare Advocacy on behalf of Connecticut home health patients. In addition, the Agreement should return approximately $100 million from Medicare over the next five years under a new Demonstration Project.

The Demonstration Project will be administered by the Center for Medicare Advocacy as agent for DSS. The Project is intended to simplify the Medicare determination process by using a sampling method instead of a case-by-case review system while demonstrating an equal return in Medicare dollars to the individual review process.

For over a decade the DSS Office of Quality Assurance has been integral to the success of the State’s Medicare maximization effort. With approval from DSS, the Center for Medicare Advocacy and the Connecticut Attorney General’s office filed and pursued the lawsuit that resulted in this settlement agreement with the federal Medicare agency.

The $33.3 million will be an important revenue stream in this extremely stressed fiscal year. As a result of support from key legislators and members of the Connecticut elder rights network, DSS has decided to continue to work with the Center to implement the new Demonstration Project for Medicare home health claims. This work will allow the Center to continue to maximize Medicare home health benefits and to monitor the success of the new Demonstration Project. While funding for the Center will be cut significantly, we are grateful for the opportunity to pursue this new endeavor and to develop additional means of continuing to advocate for Connecticut’s elders and people with disabilities.