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Disabled Senior Citizen Wins Again Over Medicare Lawyers

She wins fight against controversial effort by Medicare to refuse care if you are not improving

Original report by Susan Jaffe, Kaiser Health News

gavel being slammed on desk by judgeOct. 30, 2014 – I’ll bet lawyers for Medicare hate to walk into a courtroom and see Glenda Jimmo, 78, sitting at the plaintiff’s table. The disabled senior with serious health problems, who successfully challenged Medicare for denying her home health care coverage, has racked up another win against the government. In the latest case, Medicare refused to pay for her care because she was not improving - the same issue she won in the first lawsuit.

She argued in her latest federal challenge filed in June that Medicare should have paid for the nursing care and other skilled services she received at her home during 2007. On Wednesday, Medicare officials agreed, invalidating an April ruling that she was not entitled to coverage because her condition had stabilized and she was not improving.


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Disabled Senior Who Led Suit Against Medicare Must Try Again

Can Medicare deny coverage because you are not getting better? Even if they say they won’t? A story every senior should read

By Susan Jaffe, Kaiser Health News - This KHN story also ran in NPR’s Shots blog.

Oct. 27, 2014 - A 78-year-old Vermont mother of four who helped change Medicare coverage for millions of other seniors is still fighting to persuade the government to pay for her own care. Glenda Jimmo, who is legally blind and has a partially amputated leg due to complications from diabetes, was the lead plaintiff in a 2011 class-action lawsuit seeking to broaden Medicare’s criteria for covering physical therapy and other care delivered by skilled professionals. More...

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“I won,” said Jimmo, who is receiving rehab therapy at a Vermont nursing home and hopes to return home soon.  “I’m very pleased. It makes me feel America is still in good shape.”

The settlement doesn’t mention that Jimmo was the lead plaintiff in a 2011 class-action lawsuit seeking to eliminate the so-called “improvement standard” as a criteria for Medicare coverage.

In the 2012 settlement that bears her name, the government agreed that improvement was not required and allowed many Medicare beneficiaries with chronic conditions and disabilities to appeal claims that had been denied because they were unlikely to get better.  Jimmo is legally blind and has a partially amputated leg due to complications from diabetes.

“This should give hope to other people who are going through the Medicare appeals process,” said Judith Stein, executive director of the Center for Medicare Advocacy, which filed the original class action lawsuit with Vermont Legal Aid and negotiated both settlements. 

“It’s helpful to know that people will get a fair shot for an appeal because if Mrs. Jimmo couldn’t, who could?”

After the 2012 settlement, Jimmo was one of the first seniors to seek a review. But Medicare’s highest appeals panel, the Medicare Appeals Council, upheld the original denial of her claims in April. Her attorneys went back to federal court, claiming the panel did not follow the principles laid out in the settlement.

Medicare officials agreed Wednesday that the Medicare Appeals Council’s denial “shall have no remaining force or effect.”  Medicare will now pay Jimmo’s home health agency nearly $12,000, as well as her attorney fees.

“Requiring improvement and denying coverage to people with chronic conditions was a serious problem that has affected many thousands of people for many, many years,” said her attorney Michael Benvenuto, director of Vermont Legal Aid’s Medicare Advocacy Project.

Medicare officials declined to comment on Wednesday’s settlement.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

More by Susan Jaffe

Some of this information is reprinted from with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

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