Medicare Savings Programs Outreach in Housing for Elders
Introduction
The Omnibus Reconciliation Act of 1986 established the qualified Medicare beneficiary program (QMB) to allow states to extend Medicaid eligibility to low-income individuals who were unable to pay Medicare premiums and cost-sharing. This law authorized federal financial assistance to states to pay for Medicaid for individuals whose income was below 100% of federal poverty guidelines and whose resources were less than the state SSI resource test or higher at state option.
Several amendments were made to the qualified low-income Medicare beneficiary program, including mandating states to provide Medicaid eligibility to this population, extending eligibility to qualified disabled working individuals and Medicare beneficiaries with income up to 175% of the federal poverty guidelines.
Despite these mandates and benefit improvements, knowledge of, and participation in, these programs and beneficiary enrollment in the Medicare Savings Program remained low. Numerous reports documented onerous application procedures, lack of information about program benefits, lack of an effective outreach strategy, delays in Medicaid payment and reimbursement of benefits and hostility by state Medicaid programs as reasons that discouraged qualified individuals from participating in the Medicare Savings programs.
To address these issues, Congress mandated that states adopt a uniform application for benefits and conduct outreach to inform prospective beneficiaries about the program. This law also required the Social Security Administration to notify beneficiaries of their potential eligibility for the Medicare Savings Program. The Robert Wood Johnson Foundation funded the State Solutions program to provide funding to states to develop innovative approaches to conduct outreach to eligible beneficiaries and increase enrollment in this program. As part of this effort, some states have explored opportunities to target various types of congregate housing facilities to perform outreach activities in and provide opportunities to apply for the Medicare Savings Programs. This outreach activity.as well as efforts by some state and local area agencies on aging, has met mixed success. This memorandum explores the advantages and disadvantages of conducting outreach in housing facilities and describes some of the lessons learned from these activities.