DUAL ELIGIBLES: States Lag in Enrollment Efforts
Two programs that extend Medicaid coverage to low-income Medicare recipients (dual-eligible seniors) are significantly underused, according to a new report by Margo Rosenbach of Mathematica Policy Research, Inc. and JoAnn Lamphere of AARP. The researchers interviewed officials in 10 states to determine how state Medicaid programs are using the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare (SLMB) programs, which offset Medicare's cost-sharing requirements for qualified low-income beneficiaries. The authors found that the two programs "fail to reach a sizable proportion of potentially eligible individuals in most states," but that "it is impossible to determine, with any precision, state-by-state participation in the QMB and SLMB programs." Calling the entitlements a "secret benefit," the authors said participation rates linger at 78% among those eligible for QMB benefits and 16% of those eligible for SLMB benefits. The study outlines several "themes" on how the program is working and on how it could be improved:
- Grassroots outreach most effectively channels eligible seniors to the program.
- States with "generous Medicaid eligibility standards" for seniors and the disabled have higher participation in both programs.
- Gaps in eligibility requirements lead to fragmentation of benefits, duplication of coverage and limits to the financial protection available to participants.
- Beneficiaries and case workers alike struggle with the daunting eligibility determinations process.
- Incompatible data systems hamper outreach and tracking efforts.
- Coordination with the Social Security Administration is also inconsistent.
The Time Is Now
The "lack of accurate enrollment data is a significant barrier" in assessing states' programs, the authors conclude. They also found that "states lack incentives to support" the programs, and are currently faced with competing priorities, such as the Children's Health Insurance Program. Calling for a national commitment to increase participation, the authors recommend improved agency coordination, enhanced financing, consensus on outreach methods and more research to examine the long-term effect on health care costs. They conclude, "Current efforts to reform Medicare provide an ideal opportunity to consider how best to protect low-income Medicare beneficiaries from burdensome out- of-pocket medical costs" (Lamphere/Rosenbach, "Budging the Gaps Between Medicare and Medicaid: The Case of QMBs and SLMBs," 1/99). The study is available from the AARP at 800-424-3410. Click here to download a pdf version of the study.