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Social Security Takeover Would Boost Enrollment in Medicare Savings Programs, Report Says

JUNE 15, 2006 -- Although they might seem obscure, Medicare Savings Programs (MSPs) aren't hard to understand—through the programs, Medicare beneficiaries with an annual income below $13,000 can save $1,000 a year in Medicare premiums for doctor care, Andy Schneider told Hill aides earlier this week.

Some three million people who qualify for the programs aren't enrolled—something aides could help change, said Schneider, a former Democratic staffer who is now a consultant on Medicaid issues. "The ball is in your court," he said at a forum sponsored by the nonpartisan Alliance for Health Reform. "You can help a lot of people—a lot of people—make their lives a whole lot better," he emphasized.

A report released June 12 lays out the reasons for low enrollment and ways to boost participation in MSPs, the goal advocated by Schneider at the forum. MSPs include the Qualified Medicare Beneficiary program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the Qualified Individual program.

Although the programs differ in how much assistance they provide, they are the same in that they all help low-income beneficiaries pay the hefty out-of-pocket costs charged by Medicare. Those costs are climbing ever higher as Part B premiums for doctor care and other Medicare out-of-pocket charges rise.

Those rising costs cause low-income beneficiaries to skip treatment, said the report by the nonpartisan National Academy for Social Insurance (NASI). Yet only 13 percent of those eligible are enrolled in the SLMB program, and only 33 percent of those eligible for SLMB have signed up for that program.

A big reason for low enrollment is lack of awareness of the MSPs; of those who are eligible but haven't enrolled, 79 percent have never heard of the programs, according to the NASI report.

State Medicaid workers are responsible for enrolling Medicare beneficiaries in MSPs, but because they are so involved in applying myriad eligibility rules in other parts of the complex Medicaid program they know little about MSPs, Kathryn Kuhmerker, former director of New York State's Medicaid program, told the forum.

Beneficiaries also shy away from enrollment because they must go to Medicaid offices to do so and they associate Medicaid with welfare, she said.

The welfare stigma would be removed as an obstacle to enrollment by having the Social Security Administration (SSA) administer MSPs, the report said. Beneficiaries could go to Social Security offices to enroll, and having those offices involved would make it easier to get the word out about the MSPs, the report added.

In addition, the data SSA gathers to determine eligibility for the low-income Medicare drug benefit "could be used to help the same people enroll in the Medicare Savings Programs," the report said.

Enrollment could further be simplified by revising eligibility and income rules for MSPs to make them consistent with those of the low-income drug benefit, the report said. That step would boost federal spending, however—something Congress would be reluctant to approve, other speakers at the forum said.

There is "some logic" to focusing on getting those eligible but not enrolled in MSPs signed up before considering expansion of the MSPs, said former Assistant Department of Health and Human Services Secretary for Legislation Jennifer Young, who is now with the lobbying firm Tarplin, Downs and Young.

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