Medicare Savings Programs (MSPs) are part of states’ Medicaid that aid millions of individuals who have limited income and resources. They provide coverage for Medicare Part A and B premiums, deductibles, and copays, promoting access to healthcare to millions nationwide.
Each month through MSPs, Medicaid pays Medicare Part A for over 700,000 and Part B premiums for over 10 million individuals. However, millions more individuals are eligible but not enrolled in any MSPs.
According to a study conducted in 2017 for the Medicaid and CHIP Payment and Access Commission (MACPAC), only about 50% of eligible Medicare beneficiaries were enrolled in MSPs.
In this article, we discuss why half of the eligible enrollees are not enrolled in MSPs and what changes the Centers for Medicare & Medicaid Services (CMS) have introduced to fix this issue.
Barriers to MSP enrollment
- Many individuals with blindness or disabilities faced exclusion from the enrollment policies implemented under the Affordable Care Act (ACA). This unfortunate procedural barrier put them at a higher risk compared to other Medicaid enrollees, as they could be denied coverage or lose it, despite meeting the eligibility criteria.
- Another barrier to enrollment was that there was no clear guidance for applicants and beneficiaries on how to go about the applications. The consistent timeframes to return information required for eligibility were also not clearly mentioned. Moreover, states had no direct instructions on when to process and act upon the information received.
Altogether, it was leading to unnecessary delays in processing applications and renewals, which resulted in some deserving individuals being denied coverage and some ineligible enrollees retaining coverage.
- From time to time, policies need to be updated. However, Medicaid recordkeeping regulations, which are critical to identifying errors, were last updated three decades ago. It resulted in inconsistent practices across states and contributed to eligibility error rates.
Streamlining Application and Enrollment
Sometimes, people who are eligible for Medicaid avoid enrolling in coverage plans because of the burdensome administrative process and unnecessary delays.
For instance, if people aged 65 or older are receiving Supplemental Security Income (SSI), they’re financially eligible for MSPs. However, the duplicative paperwork involved makes it so much more difficult for them to enroll.
In a significant move, the Department of Health and Human Services (HHS) has recently concluded the finalization of a rule, in collaboration with the Centers for Medicare & Medicaid Services (CMS). This final rule aims to streamline the enrollment process for Medicare Savings Programs (MSPs), ultimately improving accessibility and affordability for an estimated 860,000 individuals.
The streamlining processes include:
- Automatically enrolling certain SSI Recipients into the Medicaid programs.
- Taking data from Medicare Part D Low-Income Subsidy (LIS) to facilitate MSP enrollment. Whoever is qualified for LIS- qualifies for MSP, too.
- The income limits for qualifying MSP enrollment are relative to the Federal poverty line (FPL)
The Impact
With this new rule, Medicaid eligibles can effortlessly enroll in the MSPs. The new rule will reduce the complexity of applications and encourage more people to get access to affordable healthcare.
The secretary of HHS, Xavier Becerra, said, “Throughout my career, I have dedicated myself to ensuring that Americans have access to health insurance so that they can survive and thrive.” Further, he said, “This rule brings us closer to that goal as we expand access and coverage for older Americans and people with disabilities.”