Lambert right here: Now cease Medicaid clawbacks. Actually, repair all clawbacks, and begin by placing a statute of limitations on them.
By David Hilzenrath and Jodie Fleischer, Cox Media Group. Initially printed at Kaiser Well being Information.
In March, newly put in Social Safety chief Martin O’Malley criticized company “injustices” that “shock our shared sense of fairness and good conscience as Individuals.”
He promised to overtake the Social Safety Administration’s typically heavy-handed efforts to claw again cash that hundreds of thousands of recipients — together with people who find themselves residing in poverty, are aged, or have disabilities — have been allegedly overpaid, as described by a KFF Well being Information and Cox Media Group investigation final 12 months.
“Harmless individuals could be badly harm,” O’Malley stated on the time.
Almost eight months since he appeared earlier than Congress and introduced a collection of coverage adjustments, and with two months left in his time period, O’Malley’s effort to repair the system has made inroads however stays a piece in progress.
As an illustration, one change, shifting away from withholding 100% of individuals’s month-to-month Social Safety advantages to get well alleged overpayments, has been a significant enchancment, say advocates for beneficiaries.
“It’s a large change,” stated Kate Lang of Justice in Growing old, who known as it “life-changing for many individuals.”
The variety of individuals from whom the Social Safety Administration was withholding full month-to-month advantages to recoup cash declined sharply — from about 46,000 in January to about 7,000 in September, the company stated.
Requested to make clear whether or not these numbers and others supplied for this text lined all applications administered by the company, the SSA press workplace didn’t reply.
One other probably vital change — relieving beneficiaries of getting to show that an overpayment was not their fault — has not been applied. The company stated it’s engaged on that.
In the meantime, the company appears to be seeking to Congress to take the lead on a change some observers see as essential: limiting how far again the federal government can attain to get well an alleged overpayment.
Barbara Hubbell of Watkins Glen, New York, known as the absence of a statute of limitations “despicable.” Hubbell stated her mom was held accountable for $43,000 due to an SSA error going again 19 years.
“In what universe is that even authorized?” Hubbell stated. Paying down the overpayment steadiness left her mom “basically penniless,” she added.
In response to questions for this text, Social Safety spokesperson Mark Hinkle stated laws is “the perfect and quickest manner” to set a time restrict.
Establishing a statute of limitations was not among the many coverage adjustments O’Malley introduced in his March congressional testimony. In an interview on the time, he stated he anticipated an announcement on it “throughout the subsequent couple few months.” It may in all probability be completed by regulation, with out an act of Congress, he stated.
Talking usually, Hinkle stated the company has “made substantial progress on overpayments,” lowering the hardship they trigger, and “continues to work diligently” to replace insurance policies.
The company is underfunded, he added, is at a close to 50-year low in staffing, and will do higher with extra staff. The SSA didn’t reply to requests for an interview with O’Malley.
O’Malley introduced the coverage adjustments after KFF Well being Information and Cox Media Group collectively printed and broadcast investigative reporting on the injury overpayments and clawbacks have completed to hundreds of thousands of beneficiaries.
When O’Malley, a former Democratic governor of Maryland, introduced his plans to a few congressional committees in March, lawmakers greeted him with uncommon bipartisan reward. However the previous a number of months have proven how arduous it may be to show round a federal paperwork that’s large, advanced, deeply dysfunctional, and, because it says, understaffed.
Now O’Malley’s time could also be operating out.
Lang of Justice in Growing old, among the many advocacy teams which have been assembly with O’Malley and different Social Safety officers, stated she appreciates how a lot the commissioner has achieved in a short while. However she added that O’Malley has “not been considering listening to about our emotions that issues have fallen quick.”
One long-standing coverage O’Malley got down to change includes the burden of proof. When the Social Safety Administration alleges somebody has been overpaid and calls for the cash again, the burden is on the beneficiary to show they weren’t at fault.
Cecilia Malone, 24, a beneficiary in Lithonia, Georgia, stated she and her dad and mom spent tons of of hours making an attempt to get errors corrected. “Why is the burden on us to ‘show’ we weren’t overpaid?” Malone stated.
It may be exceedingly troublesome for beneficiaries to attraction a call. The alleged overpayments, which may attain tens of hundreds of {dollars} or extra, typically span years. And folks struggling simply to outlive might have additional problem producing monetary data from way back.
What’s extra, in letters demanding reimbursement, the federal government doesn’t sometimes spell out its case towards the beneficiary — making it arduous to mount a protection.
Testifying earlier than Home and Senate committees in March, O’Malley promised to shift the burden of proof.
“That must be on the company,” he stated.
The company expects to finalize “steerage” on the topic “within the coming months,” Hinkle stated.
The company factors to lowered wait instances and different enhancements in a telephone system identified to depart beneficiaries on maintain. “In September, we answered calls to our nationwide 800 quantity in a mean of 11 minutes — an amazing enchancment from 42 minutes one 12 months in the past,” Hinkle stated.
Nonetheless, in response to a nonrepresentative survey by KFF Well being Information and Cox Media Group targeted on overpayments, about half of respondents who stated they contacted the company by telephone since April rated that have as “poor,” and few rated it “good” or “glorious.”
The survey was despatched to about 600 individuals who had contacted KFF Well being Information to share their overpayment tales since September 2023. Virtually 200 individuals answered the survey in September and October of this 12 months.
Most of those that stated they contacted the company by mail since April rated their expertise as “poor.”
Jennifer Campbell, 60, a beneficiary in Nelsonville, Ohio, stated in late October that she was nonetheless ready for somebody on the company to observe up as described throughout a telephone name in Could.
“VERY POOR customer support!!!!!” Campbell wrote.
“Almost unimaginable to come up with somebody,” wrote Kathryn Duff of Colorado Springs, Colorado, who has been serving to a disabled member of the family.
Letters from SSA have left Duff mystified. One was postmarked July 9, 2024, however dated greater than two years earlier. One other, dated Aug. 18, 2024, stated her member of the family was overpaid $31,635.80 in advantages from the Supplemental Safety Revenue program, which supplies cash to individuals with little or no earnings or different sources who’re disabled, blind, or no less than 65. However Duff stated her relative by no means obtained SSI advantages.
What’s extra, for the dates in query, funds listed within the letter to again up the company’s math didn’t come near $31,635.80; they totaled a couple of quarter of that quantity.
Relating to the 100% clawbacks, O’Malley in March stated it’s “unconscionable that somebody would discover themselves dealing with homelessness or unable to pay payments, as a result of Social Safety withheld their whole fee for restoration of an overpayment.”
He stated that, beginning March 25, if a beneficiary doesn’t reply to a brand new overpayment discover, the company would default to withholding 10%. The company warned of “a brief transition interval.”
That change wasn’t automated till June 25, Hinkle stated.
The variety of individuals newly positioned in full withholding plummeted from 6,771 in February to 51 in September, in response to information the company supplied.
SSA stated it will notify recipients they may request lowered withholding if it was already clawing again greater than 10% of their month-to-month checks.
Nonetheless, dozens of beneficiaries or their relations informed KFF Well being Information and Cox Media Group they hadn’t heard they may request lowered withholding. Amongst those that did ask, roughly half stated their requests have been accredited.
Based on the SSA, there was virtually a 20% decline within the variety of individuals dealing with clawbacks of greater than 10% however lower than 100% of their month-to-month checks — from 141,316 as of March 8 to 114,950 as of Oct. 25, company spokesperson Nicole Tiggemann stated.
In the meantime, the variety of individuals from whom the company was withholding precisely 10% soared greater than fortyfold — from simply over 5,000 to properly over 200,000. And the variety of beneficiaries having any partial advantages withheld to get well an overpayment elevated from virtually 600,000 to virtually 785,000, in response to information Tiggemann supplied.
Lorraine Anne Davis, 72, of Houston, stated she hasn’t obtained her month-to-month Social Safety fee since June resulting from an alleged overpayment. Her Medicare premium was being deducted from her month-to-month profit, so she’s been left to pay that out-of-pocket.
Davis stated she’s going to want a kidney transplant and had been making an attempt to economize for when she’d be unable to work.
A letter from the SSA dated April 8, 2024, two weeks after the brand new 10% withholding coverage was slated to take impact, stated it had overpaid her $13,538 and demanded she pay it again inside 30 days.
Apparently, the SSA hadn’t accounted for a pension Davis receives from abroad; Davis stated she disclosed it when she filed for advantages.
In a letter to her dated June 29, the company stated that, below its new coverage, it will change the withholding to solely 10% if she requested.
Davis stated she requested by telephone repeatedly, and to no avail.
“No one appears to know what’s occurring” and “nobody appears to have the ability to enable you to,” Davis stated. “You’re simply held captive.”
In October, the company stated she’d obtain a fee — in March 2025.
Marley Presiado, a analysis assistant on the Public Opinion and Survey Analysis crew at KFF, contributed to this report.
[Clarification: This article was revised at 9 a.m. ET on Nov. 18, 2024, to add the word “partial” in this sentence: “And the number of beneficiaries having any partial benefits withheld to recover an overpayment increased from almost 600,000 to almost 785,000, according to data Tiggemann provided.”]
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