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Millions of diabetes patients are missing out on Medicare’s nutrition help

LOUISIANA WEEKLY — The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million enrollees in private Medicare Advantage plans.

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Glucose meter with result sugar level, healthy food, dumbbells and centimeter, diabetes (Photo by: Ratmaner)

By Phil Galewitz

(Special from khn.org) — Louis Rocco has lived with diabetes for decades but, until he met with a registered dietitian in August, he didn’t know eating too much bread was dangerous for him.

“I’m Italian, and I always eat a lot of bread,” he said. After two hour-long visits with a dietitian — including a session at his local grocery store in Philadelphia — Rocco, 90, has noticed a difference in his health.

“It’s helped bring down my sugar readings,” he said of changes in his diet including eating less bread. “I wish I knew I could have had this help years ago.”

After getting a referral this summer from his doctor, Rocco learned that Medicare covers personal nutritional counseling for people with diabetes or kidney disease.

The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million enrollees in private Medicare Advantage plans.

Health experts say the little-used benefit represents a lost opportunity for beneficiaries to improve their health — and for the program to save money by preventing costly complications from the diseases.

An estimated one in four people 65 and older have diabetes and one in three have chronic kidney disease. Kidney disease is often a complication of diabetes.

The prevalence of diabetes has risen markedly in the past 20 years and the condition is more common as people age.

Nationwide, there are 100,000 registered dietitians — more than enough to meet demand, said Krista Yoder Latortue, executive director of Family Food in Philadelphia, which employs about 50 dietitians including the one who visited Rocco. Medicare data showed about 3,500 dietitians billed the program for nutritional counseling in 2017.

The problem may be that not enough physicians know about the Medicare benefit. Doctors have to refer patients to a dietitian.

Congress approved the benefit, which began in 2002, after studies found medical nutrition counseling leads to improved health outcomes and fewer complications for older patients. Under the preventive health provisions of the Affordable Care Act, the counseling has been available without out-of-pocket costs to Medicare beneficiaries since 2011.

Medicare pays for three hours of dietary counseling during the first year the benefit is used and two hours in subsequent years. A doctor can appeal to Medicare for additional nutritional therapy if the physician believes it is medically necessary.

Larry Lipman, 70, of Falls Church, Va., said he was shocked to learn he had diabetes earlier this year because he’s relatively thin and is an avid cyclist.

When his doctor recommended meeting with a dietitian, he not only said yes but also brought along his wife, who does most of the cooking.

“It was great because I could ask specific questions and get into the nitty-gritty about how I eat, what I eat and when I eat,” said Lipman, a retired journalist.

“I’ve learned I needed to cut down on portion sizes of rice and other things to keep my carbohydrates down,” he said. “I’m thinking more about what I eat every time and staying away from Doritos and ice cream.”

Doctors shoulder some of the blame for patients not getting dietary counseling by failing to refer them to dietitians.

“It’s a lot easier to prescribe a medication than it is to discuss the importance of nutrition and get patients to meet with a registered dietitian,” said Dr. Holly Kramer, a Chicago nephrologist and president of the National Kidney Foundation.

“I don’t understand how we have this burgeoning obesity and diabetes epidemic and we are not using dietitians in our clinics for all these patients, yet we are paying for all these things that mediate from the disease process such as arthritis, dialysis and amputations,” she said.

Jennifer Weis, a registered dietitian in Philadelphia, said the limited hours Medicare covers is frustrating given how difficult it is to change behaviors in older adults.

“It’s better than nothing, but in my mind is not sufficient,” she said.

Doctors might not be aware of the Medicare option since “it’s a challenge to keep up with what is a covered benefit and what is not,” said Dr. Michael Munger, chairman of the American Academy of Family Physicians who practices in Overland Park, Kan. He said that many doctors who don’t practice with a large health system may not be familiar with dietitians in their community.

For convenience, Munger said, he refers his diabetes patients to a nurse practitioner in his office for nutritional counseling. But only registered dietitians are covered under the Medicare benefit, so his Medicare patients face a copayment for that service.

Nutritional counseling is not the only underused Medicare benefit that can prevent health complications.

Fewer than five percent of Medicare beneficiaries use their 10 to 12 hours of diabetes self-management training benefit, which can cover individual and group sessions providing tips for eating healthily, being active, monitoring blood sugar, taking drugs and reducing risks.

Part of the problem, said Yoder Latortue in Philadelphia, is there is a lot of misinformation about whom the public can trust on nutrition advice.

“Everyone eats and everyone has an opinion,” Yoder Latortue said.

Lauri Wright, a Jacksonville, Fla., registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, said the federal Centers for Medicare & Medicaid Services sends out notices to health providers once a year but more information is needed.

About 10,600 registered dietitians have enrolled to treat Medicare patients, a CMS spokeswoman said. She said the agency has been advising health providers about the benefit and promoting it to enrollees on its website and its annual handbook that it sends to beneficiaries.

Still, “I think because only two diseases are covered by Medicare and the rest aren’t, it falls off everybody’s radar,” Wright said.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

This article originally published in the September 16, 2019 print edition of The Louisiana Weekly newspaper.

This article originally appeared in The Louisiana Weekly.

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COMMENTARY: Women of Color Shape Our Past and Future

MINNESOTA SPOKESMAN RECORDER — Every March, Women’s History Month invites us to pause and honor the women whose courage, intellect, and leadership have shaped our world. This year, that invitation feels especially urgent. We are living in a time when history is being rewritten, when DEI is being recast as a threat, and when the stories we choose to uplift matter more than ever. The stories of women of color must be centered, celebrated, and carried forward with intention.

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Women of Color Leadership Shapes the Legacy of Women’s History Month

By Dr. Sharon M. Holder | Minnesota Spokesman Recorder

Women’s History Month offers an opportunity to recognize the enduring impact of women of color leadership across history and in the present day. From Harriet Tubman and Shirley Chisholm to today’s leaders in science, politics and culture, women of color continue to shape movements, institutions and communities through courage, collaboration and vision.

Every March, Women’s History Month invites us to pause and honor the women whose courage, intellect, and leadership have shaped our world. This year, that invitation feels especially urgent. We are living in a time when history is being rewritten, when DEI is being recast as a threat, and when the stories we choose to uplift matter more than ever. The stories of women of color must be centered, celebrated, and carried forward with intention.

For centuries, women of color have been architects of progress, even when history tried to confine them to the margins. They have led movements, built institutions, transformed culture, and expanded the boundaries of justice, leadership, and community. Their contributions are not postscripts; they are landmarks. Yet too often, their brilliance has been acknowledged only in hindsight. Women’s History Month offers a chance to correct that imbalance, not only by remembering the past, but by recognizing their leadership unfolding before us.

This legacy lives in Harriet Tubman, whose courage and strategic brilliance transformed the Underground Railroad into one of the boldest freedom operations in American history. In Barbara Jordan, whose moral clarity reshaped the nation’s understanding of justice and constitutional responsibility. In Madam C. J. Walker, expanding both the beauty industry and the economic horizons of Black women. It dances in Josephine Baker, who challenged racism and resisted fascism. In Ida B. Wells and Dolores Huerta, who wielded truth and determination in pursuit of justice. In Chien-Shiung Wu, whose experiments altered science, and Shirley Chisholm, whose political courage expanded the very definition of leadership. These women did more than break barriers; they built new worlds.

A powerful throughline in the leadership of women of color is how they lead: collaboratively, creatively, relationally, and with deep responsibility to community. Their leadership is grounded not in hierarchy but in connection, in the belief that progress is something we build together.

We see this in Kamala Harris, whose presence expands the boundaries of possibility; in Ketanji Brown Jackson; in Oprah Winfrey; and in Toni Morrison, who insisted that the interior lives of Black women are essential to the human story. It resonates in Simone Biles and Serena Williams, redefining strength through excellence and self-belief.

Today, women of color continue to drive breakthroughs in medicine, technology, the arts, politics, and environmental justice. Their leadership appears not only in boardrooms or public office, but in mentorship, advocacy, and the daily navigation of systems never designed for them. The spirit shines in Mae Jemison and Ellen Ochoa; in Michelle Obama; and in the brilliance of Katherine Johnson, Dorothy Vaughan, Mary Jackson, and Christine Darden, whose work helped launch a nation into space.

Celebration is important, but it is not enough. Honoring women of color requires intentional action rooted in equity. It means creating environments where their voices are valued, challenging the biases that shape who is recognized, and ensuring progress is shared.

As we celebrate Women’s History Month, let us honor women of color not as symbols, but as leaders whose work continues to guide us. When we uplift women of color, we honor history and shape the future.

Dr. Sharon M. Holder lives in South Carolina. She holds a PhD/MPhil in Gerontology from the Center for Research on Aging at the University of Southampton, UK; a Master of Science in Gerontology from the Institute of Gerontology at King’s College London, UK; and a Master of Social Work from the Graduate College of Social Work at the University of Houston, Texas.

Dr. Holder discovered her love of poetry at the University of Houston–Downtown, where she published in The Bayou Review and the Anthology of Poetry. Today, she writes poetry as a practice of gratitude alongside her academic research.

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Woman’s Search for Family’s Roots Leads to Ancestor John T. Ward – A Successful Entrepreneur and Conductor on the Underground Railroad

THE AFRO — For years, she wanted to know more about her ancestor John T. Ward, she said, and her curiosity eventually became an obsession, leading her to become the genealogist for her family. And so, for more than a decade, she set out to trace her family’s roots and discovered a story that would change her life and the way she viewed American history. 

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By D. Kevin McNeir | Special to The AFRO 

Shanna Ward, the owner of a publishing company and insurance agency located in Columbus, Ohio, said the elders in her family often say she inherited her entrepreneurial spirit from one of their ancestors – a formerly enslaved child from Virginia whose freedom came through manumission in 1827.

For years, she wanted to know more about her ancestor John T. Ward, she said, and her curiosity eventually became an obsession, leading her to become the genealogist for her family. And so, for more than a decade, she set out to trace her family’s roots and discovered a story that would change her life and the way she viewed American history.

John T. Ward would help others secure their freedom and justice in his roles as a conductor on the Underground Railroad, an abolitionist, and political activist. But realizing that economic freedom was essential to his and his family’s survival, he and his son founded the Ward Transfer Line in 1881 (now E.E. Ward Moving) – one of America’s oldest Black-owned businesses. While it has transferred ownership, the business remains in operation today.

Shanna Ward recently published a book about her ancestor, “The Bequest of John T. Ward,” which she hopes can be added to other unheralded tales of Black resistance that occurred during America’s antebellum period.

“Originally, I just wanted to write a 100-page story when I first began digging and was encouraged after I found a copy of a will dated 1827 which included him and was a rare example of a mass manumission,” Shanna Ward said. “Three of the slaves, including John’s grandfather, were given about 294 acres of land in the will, but all the former slaves were supposed to remain on the plantation until their 21st birthday. Some refused to remain. That’s how our family got to Ohio.”

Ward said she learned that newly freed Blacks, including her ancestors in Ohio, had to fend for themselves and often did so with amazing results given the obstacles they faced.

“In those days there were no civil rights organizations, and in local communities, Blacks formed and supported Black-owned businesses, took their own census recordings, and became involved in local politics – all without White involvement,” she said.

BOOK COVER: The cover of the book “The Bequest of John T. Ward,” written by Shanna Ward about her ancestor who, as a child, was granted his freedom in 1827 and went on to become a successful business owner in Ohio, a political activist, and a conductor on the historic Underground Railroad.

BOOK COVER: The cover of the book “The Bequest of John T. Ward,” written by Shanna Ward about her ancestor who, as a child, was granted his freedom in 1827 and went on to become a successful business owner in Ohio, a political activist, and a conductor on the historic Underground Railroad.

“There is part of Ohio where, during the days of slavery, if you successfully crossed the river you were free,” she said. “That was where Black life began – across the river in freedom. When we understand ourselves as more than property and uncover tales of survival which are the foundation of our legacy, then we can better understand who we are and what our ancestors endured. We are stronger than we are often led to believe.”

Efforts among African Americans to learn their family roots have increased over the past several decades, particularly given the success of the PBS documentary, “Finding Your Roots,” hosted and narrated by Harvard University professor Dr. Henry Louis Gates Jr.

On the show’s website, Gates said he developed the show in 2012 in efforts to continue his quest to “get into the DNA of American culture.”

In each episode, celebrities view ancestral histories and share their emotional experience with viewers. Gates attributes the success of the show to a significant surge in interest among Black Americans in tracing their family roots and a desire to reconnect with ancestral history that was severed by slavery.

JOHN T. WARD: John T. Ward, the historic patriarch in a family whose roots can be traced to the days of slavery in Virginia, is the subject of a new book written by a member of his proud family, Shanna Ward, called “The Bequest of John T. Ward.”

JOHN T. WARD: John T. Ward, the historic patriarch in a family whose roots can be traced to the days of slavery in Virginia, is the subject of a new book written by a member of his proud family, Shanna Ward, called “The Bequest of John T. Ward.”

“Advancements in DNA testing have increased accessibility of records and led to a cultural push to reclaim identity beyond the ‘brick wall’ of 1870,” said Gates who noted that the 1870 U.S. Census represents the first time former slaves were listed by name and, unfortunately, serves as the point where records of their lives often stop and cannot be traced any earlier.

In a recent paper published in the journal “American Anthropologist,” University of Illinois Urbana-Champaign anthropology professor LaKisha David posits that by using genetic genealogy, African Americans now have the real possibility of restoring family narratives that were disrupted, severed and destroyed by institutional slavery.

“For African Americans who have grown up with a sense of ancestral loss and disconnection, this reclamation of family history is deeply humanizing and healing,” she writes. “It replaces the genealogical unknown with tangible knowledge of ancestral histories and kinship ties.

“Identifying African ancestors and living relatives is an act of restorative justice. It is ultimately about (re)claiming the humanity, dignity, and agency of enslaved Africans and their descendants, which is an essential component of repairing the harms of slavery.”

Ward said by uncovering her family’s truth, she has established a platform for education and empowerment for herself, her children, and today’s youth.

“I realized how important it is to pass down our own stories to the next generation,” Ward said. “There’s so much our children need to know about the Underground Railroad, the quilt codes created by Black women, and other examples of unrecorded heroics and bravery exhibited by Black men and women. Their collective efforts led to the end of Jim Crow laws and the securing of equal rights in the U.S. Constitution for African Americans. If you look hard enough, I believe everyone has someone like Harriet Tubman or Frederick Douglass in their family.”

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Advocates Raise Alarm Over ICE Operation, MOU and Detention Risks in Baltimore County

THE AFRO — “This is highly problematic given many of the charges that land people in county correctional facilities to begin with are for misdemeanors of which they may not even ultimately be proven guilty and convicted,” said Cathryn Ann Paul Jackson, public policy director for We Are CASA. “It results in a subversion of the local criminal justice system as a means to further racial profiling and do ICE’s dirty work.”

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By Megan Sayles | AFRO Staff Writer
msayles@afro.com

As U.S. Immigration Customs and Enforcement (ICE) operations intensify nationwide, community organizations have become the eyes and ears of their neighborhoods—monitoring the agency’s presence and alerting residents to protect themselves and their neighbors.

In Baltimore County, nonprofits like We Are CASA have observed a spectrum of enforcement actions.

“We have seen a range of activity, including traffic stops and ICE showing up in neighborhoods or in seeming response to tips,” said Cathryn Ann Paul Jackson, public policy director for We Are CASA. “Beyond actual ICE activity in Baltimore County, we have seen many detentions of Baltimore County residents across the DMV, as community members tend to travel across counties and cities for work.”

We Are CASA, a national nonprofit headquartered in Maryland, is dedicated to empowering and improving the quality of life for working-class Black, Latino, Afro-descendent, Indigenous and immigrant communities. Jackson’s personal connection to this mission led her to the organization. A daughter of immigrants from Guyana and Trinidad, she said she grew up witnessing firsthand how immigration policy can define families’ safety, opportunity and sense of belonging.

She said the locations and times of ICE operations in Baltimore County have varied over time.

“We have consistently seen ICE arrest people at their check-in appointments, which were ironically created as an alternative to detention and are now being abused to trap people into custody,” said Jackson. “For a period of time, we were witnessing a significant amount of arrests along the Baltimore-Washington Parkway by U.S. Park Police, who were using a previously rarely enforced law against driving commercial vehicles on this road as a pretext to profile immigrant drivers, detain them and hand them over to ICE.”

Last fall, Baltimore County entered into a Memorandum of Understanding (MOU) with ICE, removing the locality from the Department of Justice’s (DOJ) sanctuary jurisdictions list and formalizing a policy for notifying ICE before the release of inmates with federal immigration detainers or judge-signed warrants.

The agreement codified an existing practice within the Baltimore County Department of Corrections. The MOU is not a 287(g) agreement, which is a partnership between local law enforcement and ICE to delegate immigration enforcement authority to police officers. Those agreements were banned by the state of Maryland on Feb. 17.

However, Jackson criticized the policy memorialized in the MOU, saying that although it is carefully drafted to avoid legal violations, it effectively allows detention centers to hold people past their court-ordered release so that ICE can take them into custody.

“This is highly problematic given many of the charges that land people in county correctional facilities to begin with are for misdemeanors of which they may not even ultimately be proven guilty and convicted,” said Jackson. “It results in a subversion of the local criminal justice system as a means to further racial profiling and do ICE’s dirty work.”

Baltimore County has said it entered into the MOU in an effort to preserve its access to federal funding. The locality explained its reasoning on a FAQ page about its removal from the DOJ’s sanctuary jurisdictions list.

“Inclusion on DOJ’s list could risk significant federal funding, on which the county and constituents depend,” the entry read. “Signing the MOU ensures that the county avoids risks to federal funding that is used to provide needed services.”

Baltimore County’s removal is not unique, as neither Maryland nor any of its counties appear on the DOJ’s list. Still, community members worry that the county’s MOU with ICE could lead to wrongful detentions and the misidentification of residents.

Immigration detainers are not always confirmation of a person’s immigration status—or lack thereof. They are requests by ICE that can be issued without a judicial determination and do not, on their own, establish a person’s legal status.

“We’re very concerned about errors occurring here in the county because of the amped up nature of this mass deportation push,” said Patterson. “This is a replacement theory-driven immigration policy. That means that at the same time we are importing White South African Afrikaaners—who at one time essentially colonized South Africa and oppressed Black South Africans—we are fast deporting people of color. All of us who are the minority can be mistaken for ‘unlawful immigrants.’”

The recent escalation in Minneapolis has heightened Patterson’s concern. He said the city has effectively been made a battleground.

Patterson said the Baltimore County NAACP wants the public to recognize that ICE operates as a militarized organization, unlike local police. He urged people to consider avoiding areas where ICE is active whenever possible and to exercise caution if they encounter agents. If approached, Patterson stressed that people verify warrants are properly signed and directed at them, assert their right to remain silent and contact an attorney before answering questions or consenting to searches.

He also encouraged residents to notify the Baltimore County NAACP of any encounters with ICE.

“We don’t want to wait for Minnesota in Maryland before speaking out about this,” said Patterson. “We want to equip our people to protect themselves behaviorally, consciously and conscientiously because these things are coming to pass. The imprint is among us and we need, therefore, to be aware.”

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