Medicaid Assistance for Medicare Beneficiaries with Low Incomes

Background

Two types of Medicaid coverage are available for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries with low incomes:

  • coverage of the full Medicaid benefit package and financial assistance with Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… premiums and cost-share; and
  • financial assistance only with Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… premiums (in some cases) and cost-sharing.

Eligibility for full Medicaid benefits and cost-sharing assistance—there are two eligibility pathways for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries with low incomes to receive the full Medicaid benefit package plus cost-sharing assistance. First, federal law generally requires states to cover older adults with low incomes who receive cash assistance through Supplemental Security Income The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… ( SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… ). An exception to this general rule gives states the option (called the Section 209b option) to use their state general assistance criteria (that was in place in 1972) instead of federal SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… rules to determine eligibility under this pathway.

The second eligibility pathway is the optional Medicaid medically needy programs for individuals who have exhausted their financial resources on their health and long-term services and supports Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… needs. States that use the Section 209b options are required to allow people to “spend down” to medically needy income and asset levels.

Other eligibility for full Medicaid benefits for older adults— federal law allows states to provide state-funded cash supplemental payments (SSP) to individuals to supplement their SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… income. These payments can be made to all individuals receiving SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… , or they may be targeted to certain groups, like those receiving care in group homes or assisted living facilities. States may also make SSPs available to individuals whose income exceeds SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… standards. States are allowed to extend full Medicaid coverage to individuals who receive SSPs. In cases where a person receives SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… and SSP, if a cost-of-living increase in their SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… payment causes them to be over income for receipt of SSP, they remain eligible for Medicaid under the Pickle Amendment, which requires these states (e.g., those that extend Medicaid eligibility to people on SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… , people receiving SSP, or both) to disregard cost-of-living increases to SSI The SSI program, implemented in 1974, was designed to reduce poverty by providing basic cash support to poor people who are aged, blind, or disabled. This federal program provides a monthly cash benefit that comes from general tax revenues. Some states supplement the basic federal… payments

Older adults may also qualify for Medicaid under the nursing facility or special income rule pathways (see also Chapter 8 Strengthening Financial Protections and Ensuring Choice for Medicaid Beneficiaries and Their Families for an explanation of these pathways)

Medicare Savings Programs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries who are not eligible for full Medicaid benefits may qualify for one of three Medicare Savings Programs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… ( MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… ). Under the MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… , Medicaid pays some or all of the individual’s Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… cost-sharing The MSP A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… has three categories, each with its own income, asset, and coverage rules, (Figure 7-3).

Tthe QMB Program is a Medicaid initiative intended to give certain Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries with low incomes full access to their Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… benefits by paying their premiums, deductibles, and copayments (Figure 7-3). State Medicaid programs have the option to pay for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Part C Medicare Advantage Medicare beneficiaries can get their Medicare benefits through Original Medicare or a Medicare Advantage Plan. If beneficiaries have Original Medicare, the government pays for Medicare benefits when they get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are… ( MA Medicare beneficiaries can get their Medicare benefits through Original Medicare or a Medicare Advantage Plan. If beneficiaries have Original Medicare, the government pays for Medicare benefits when they get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are… ) for those Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries who elect to enroll in MA Medicare beneficiaries can get their Medicare benefits through Original Medicare or a Medicare Advantage Plan. If beneficiaries have Original Medicare, the government pays for Medicare benefits when they get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are… plans covering Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Part A and B benefits and mandatory supplemental benefits. Regardless of whether the state Medicaid agency opts to pay the Part C premium, the QMB is not liable for any coinsurance A form of health care cost sharing in which a percentage of covered expenses must be paid by the insured person.  Different from a copayment (copay) which is usually a flat dollar amount.  or deductibles for Part C benefits.

When qualifying people for MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… , states may use less restrictive income-counting rules to increase income and asset limits The value of assets a person or family can have and still qualify for public assistance benefits. for their MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… , making more people eligible for both MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… and the Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Part D low-income subsidy (LIS) program. Although MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… do not pay cost-sharing for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Part D, people enrolled in MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… are also eligible for the LIS program.

States may use less restrictive income-counting rules to raise income and asset limits The value of assets a person or family can have and still qualify for public assistance benefits. for their MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… . This makes more people automatically eligible for the Low-Income Subsidy program.

Medicaid Assistance for Medicare Beneficiaries with Low Incomes

Payment issues for qualified Medicare beneficiaries Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… ( QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… )—federal law bars Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… providers from billing QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… for the difference between what they are paid and what they charge—a practice known as balance billing. The law states that the amount of money paid by Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and a state (if any) for health services provided to a QMB must be considered payment in full. Providers are also prohibited from billing QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… cost-sharing, including deductibles, coinsurance A form of health care cost sharing in which a percentage of covered expenses must be paid by the insured person.  Different from a copayment (copay) which is usually a flat dollar amount.  , and copayments. QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… have no legal obligation to make further payment to a provider (including an MCO) for Part A or Part B cost-sharing.

In theory, QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… should have full access to Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Parts A and B providers without any cost-sharing liability. Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… would pay its portion and Medicaid would cover the remainder of the Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… -approved amount that reflects the beneficiary’s cost-sharing obligation. However, in practice, the QMB Program fails to fulfill its promise because federal law allows states to cap their contributions to Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… cost-sharing at Medicaid provider-payment rates, which are generally much lower than Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… rates for the same service.

The prohibition on balance billing of QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… has led providers to complain that they are not adequately reimbursed by Medicaid. This could compromise beneficiary access. In addition, some providers continue to balance-bill beneficiaries even though this practice is contrary to federal law. Providers who inappropriately balance-bill QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… are subject to sanctions. They are also violating their provider agreement with Centers for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… & Medicaid Services.

Advocates report that QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… frequently go without needed care because they cannot find specialists, mental health professionals, and other providers willing to serve them because of the crossover payment issue.

Payment procedures create another barrier to provider participation because many states, despite Centers for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… & Medicaid Services guidance to the contrary, require Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… providers seeking copayments to go through cumbersome application procedures to receive them. States often reject reimbursement requests outright if providers are not also enrolled in Medicaid.

QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… who are able to find Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… providers may face demands for copayments that they do not owe. Protections against balance billing are not well understood by providers. Though both state and federal authorities have enforcement remedies available, they are rarely used. The practical impact of these many deficiencies is that QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… find that when they need to use their benefit, it is largely unavailable to them.

MEDICAID ASSISTANCE FOR MEDICARE BENEFICIARIES WITH LOW INCOMES: Policy

Adequate funding

In this policy: FederalState

The Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Savings Program ( MSP A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… ) should be fully funded to ensure that all eligible individuals have financial access to its benefits.

Enrollment maximization

In this policy: FederalState

Federal and state governments should work together to identify strategies to maximize enrollment in MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… .

Federal and state governments should ensure that Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries and social services personnel are adequately informed of the program’s eligibility requirements and benefits.

Modify or Eliminate the Asset Limit

In this policy: FederalState

Congress should eliminate the asset test for MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… or make it less restrictive.

Alternatively, states should use existing statutory flexibility to eliminate or modify asset tests. A state can use less restrictive resource requirements by disregarding all resources or by increasing what can be excluded from countable assets.

Income Test

In this policy: State

Where fiscally feasible, states should take advantage of the opportunity to increase income eligibility for their MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… . A state can use less restrictive requirements by increasing what can be excluded from countable income.

Increase enrollment

In this policy: FederalState

State governments should be required to monitor QMB, SLMB SLMB eligibility extends to all Medicare beneficiaries with incomes between 100 percent and 120 percent of the federal poverty level and whose assets are not greater than two times the Supplemental Security Insurance minimum. For eligible beneficiaries a state’s Medicaid program will… , and QI participation rates and report enrollment rates to the federal government on an ongoing basis. States should also be required to develop and implement outreach and enrollment activities in areas with low Qualified Medicare Beneficiaries Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… (QMB), Specified Low-Income Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Beneficiary (SLIMB), and Qualifying Individuals (QI) enrollment. States should give special attention to access problems in rural areas. Federal and state policymakers should work together to identify ways to use existing data sources to identify and enroll MSP A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… -eligible individuals.

 

Medicaid Buy-In

In this policy: FederalState

Medicaid buy-in protections for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… premiums, deductibles, and coinsurance A form of health care cost sharing in which a percentage of covered expenses must be paid by the insured person.  Different from a copayment (copay) which is usually a flat dollar amount.  should be extended to Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries with income up to 200 percent of the federal poverty The federal government defines “poverty” as income below specific amounts that the Bureau of the Census establishes. These thresholds, known as federal poverty levels (FPL), are adjusted annually for inflation and vary according to family size and the age of the head of the family. … level.

 

Increase Outreach and Education

In this policy: FederalState

The Centers for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… & Medicaid Services, the Social Security Administration, and other federal agencies with jurisdiction over programs for older adults with low incomes should fund state outreach, education, and enrollment efforts for the MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… , and should lead efforts to simplify the application process.

Federal agencies with jurisdiction over programs for older adults with low incomes, including the Social Security Administration, should ensure that the individuals they serve are aware of Medicaid, especially its QMB, SLMB SLMB eligibility extends to all Medicare beneficiaries with incomes between 100 percent and 120 percent of the federal poverty level and whose assets are not greater than two times the Supplemental Security Insurance minimum. For eligible beneficiaries a state’s Medicaid program will… , and QI protections. These agencies should lead efforts to develop intensive outreach initiatives and simplified application processes. Outreach efforts that have shown to be more effectively or efficiently performed at the federal level should be implemented by the appropriate federal agencies and funded adequately.

States should

  • simplify their administrative procedures so that eligible beneficiaries will be more likely to enroll in MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… ;
  • develop simplified applications and consumer-friendly application sites, institute passive renewal processes, and eliminate burdensome documentation requirements;
  • conduct innovative grassroots outreach to educate seniors about Medicaid, particularly the MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… —innovations should include new outreach methods and sites, including by involving volunteer organizations; and
  • make use of all available data to identify and enroll people eligible for MSPs A term used to refer collectively to several programs established under federal law to provide additional financial protections (such as assistance with premiums and/or cost-sharing) to low-income Medicare beneficiaries who meet income and asset criteria. The Medicare Savings Programs… .

Payment of full cost-sharing

In this policy: FederalState

Federal and state governments should examine the extent to Medicaid’s failure to pay the full Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… deductibles and copayments for QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… threatens access to care. If access is compromised, states should be required to pay the full cost-sharing obligation even if it exceeds the Medicaid payment rate.

 

Enforcement of the prohibition on balance billing

In this policy: FederalState

Federal and state governments should actively enforce the protections against the balance billing of Qualified Medicare Beneficiaries Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… by providers.

Federal and state governments should develop and implement strategies to identify QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… who receive bills from providers and should educate both beneficiaries and providers about the federal prohibition on balance billing.

Improved identification cards

In this policy: FederalState

Federal and state governments should collaborate in the development of improved identification cards for QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… that include clear instructions for providers on rules for serving QMBs Individuals who are eligible to “buy in” to Medicaid under the Medicare Catastrophic Coverage Act. (Congress repealed most of the other provisions of this statute in 1989.) QMB eligibility extends to all Medicare beneficiaries whose incomes fall below the federal poverty line and whose… .