Increased Funding for Medicaid Enrollment Systems May Benefit Medicare Consumers
The Centers for Medicare & Medicaid Services (CMS) released a final rule last week that increases federal funds available to state Medicaid programs to upgrade enrollment technology, which will help facilitate streamlined enrollment in Medicaid. Such increased funding is important as states prepare for implementation of the Affordable Care Act’s (ACA’s) expansion of the Medicaid program, but it can also be used to improve enrollment systems for people with Medicare who also have some form of Medicaid. Specifically, the rule increases the Federal Medical Assistance Percentages (FMAP) from 50 percent to 90 percent for development and upgrades of new systems through 2015.
Medicare Rights Center is working with states and CMS to encourage states to update enrollment systems for all people who qualify for Medicaid. This includes people with Medicare who also have Medicaid, known as dual eligibles, and those who use other types of Medicaid support, including Medicare Savings Programs (MSPs). MSPs, which are administered through state Medicaid agencies, help Medicare consumers with limited incomes pay for Medicare premiums and cost-sharing. However, antiquated enrollment systems, which use outdated technology that in some cases dates back to the 1970s, often cause delays for individuals enrolling in Medicaid or MSP benefits for the first time, and for those who wish to recertify, or re-enroll, in these programs. Modernization of these systems would mean greater efficiency and better access to Medicaid programs for people with Medicare.
Two recent papers released by the Medicare Rights Center highlight issues related to enrollment. “Streamlining Medicare and QMB Enrollment for New Yorkers: Medicare Part A Buy-In Analysis and Policy Recommendations,” discusses how improved enrollment and data exchanges would ensure that people with limited incomes are able to obtain Medicare if they would otherwise be unable to afford it. “Recertification in New York State: The Revolving Door of the Medicare Savings Program,” released just last month, explores how modernized, more automated enrollment and recertification processes would improve access to these programs.
Read the comments on federal funding for Medicaid eligibility determination and enrollment.
Read the final rule on federal funding for Medicaid eligibility determination and enrollment.
Read “Streamlining Medicare and QMB Enrollment for New Yorkers: Medicare Part A Buy-In Analysis and Policy Recommendations.”
Read “Recertification in New York State: The Revolving Door of the Medicare Savings Program.”
CMS Funds States to Innovate for Dual Eligibles
As a result of the Affordable Care Act (ACA), fifteen states have received up to $1 million in funding to begin planning and developing programs that will better integrate and coordinate care for individuals with both Medicare and Medicaid, also known as dual eligibles. The Center for Medicare and Medicaid Innovation (CMMI) in conjunction with the Federal Coordinated Health Care Office (FCHCO), both of which are housed at the Centers for Medicare & Medicaid Services (CMS), will administer funding and work with states in the planning phase and beyond, with the ultimate goal of improving dual-eligibles’ health and patient experience. Programs will also aim to achieve greater efficiencies and savings through better coordination of primary, behavioral, and acute care and long-term care services and supports.
There are an estimated 9 million individuals in the United States who are dually eligible for Medicare and Medicaid. According to the Kaiser Family Foundation, dual-eligible individuals comprise about one-fifth of the Medicare population, but they account for 36 percent of Medicare spending. Even more surprising, dual eligibles account for 40 percent of Medicaid spending, even though they represent only 15 percent of the Medicaid population. While the budget proposal recently passed by the House of Representatives would dramatically reduce the availability of services to the dual-eligible population, the ACA and the recent budget framework released by the Obama Administration call for achieving savings through better care coordination that aims to eliminate unnecessary drivers of cost, such as the administration of duplicative services. The 15 states receiving funding are California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington and Wisconsin.
Read more about State Demonstrations to Integrate Care for Dual Eligible Individuals on the CMS website.
Learn more about CMMI and State Demonstrations to Integrate Care for Dual Eligible Individuals.
Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited finances. There are three main programs, and each has different income eligibility limits.
- Qualified Medicare Beneficiary (QMB): Pays for Medicare Part A and B premiums, deductibles and coinsurance or co-pays. If you have QMB, you should have no Medicare coinsurance or copayment for Medicare-covered services you get from doctors who participate in Medicare, or who are in your Medicare private health plan’s network.
- Specified Low-income Medicare Beneficiary (SLMB): Pays for the Medicare Part B premium.
- Qualifying Individual (QI) Program: Pays for the Medicare Part B premium.
To qualify for an MSP, you must have Medicare Part A and meet income and assets guidelines. If you do not have Part A but meet QMB eligibility guidelines, your state will have a process to allow you to enroll in Part A and QMB. Many states allow this throughout the year, but others limit when you can enroll in Part A.
States use different rules to count your income (money you take in, such as wages or Social Security payments) and assets (resources such as checking accounts, stocks and some property) to determine if you are eligible for an MSP. Certain income or assets may not count. Some states do not have an asset limit.
Learn more about MSPs at www.MedicareInteractive.org.
The U.S. House of Representatives on Friday passed a budget that ends Medicare as we know it. The budget replaces guaranteed Medicare benefits with a capped voucher that consumers can use to buy private insurance, but the average consumer would need to spend $6,400 to $7,000 more per year for comparable coverage. This is especially troublesome considering that nearly 50 percent of people with Medicare have annual household incomes of $20,000 or less. Furthermore, the House budget does nothing to address the root of Medicare costs—rising costs across the entire health care sector—and it repeals the Affordable Care Act, which contains sensible reforms that do not reduce benefits for consumers.
Read Medicare Rights Center President Joe Baker’s statement on the passage of the House budget.
Last week on a CNN blog, Joe Baker answered questions about the current budget debate and proposed changes to Medicare.
Read his answers.