LTC Bullet:  The Welfare Rush

Friday, April 19, 2002

Baltimore, Maryland--

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LTC E-Alert #112--Fit for Life

LTC E-Alert #113--On Age and Alcohol

LTC E-Alert #114--Double Downs on LTC

LTC E-Alert #115--Don't Count on VA Benefits

LTC E-Alert #116--Advocates vs. Industry and Government on NH Feeding Assistants

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What if you implemented some wonderful new welfare programs, but most eligible people didn't bother to apply for them?  Wouldn't you go back to the drawing board and design something the public needs and wants?  Not if you're the Center for Medicare Education (  Their answer is to advertise the shunned programs widely, to perform "outreach" in order to locate people financially eligible to apply, and then to reduce or eliminate barriers to participation, such as the requirement that applicants provide proof of financial eligibility. 

The "Medicare Savings Programs," also known as Medicare Assistance Programs or Medicaid Buy-in Programs, are designed to provide financial assistance to low and moderate income Medicare beneficiaries who do not qualify for the full Medicaid benefits package.  In other words, these programs use Medicaid (i.e. public welfare) money to pay the Medicare premiums, co-insurance, and deductibles of "dual eligibles" (people who qualify for both Medicare and for these special Medicaid-financed programs.)  You can get the details about all four programs from the Center for Medicare Education's "issue brief" on the subject titled "Increasing Enrollment for the Medicare Savings Programs" (  Our focus here is on the lack of voluntary public participation in the programs and on the insistence of senior advocates that potential applicants must be somehow tracked down and signed up.

Here are some excerpts from the report followed by our "LTC Comment" analyzing their meaning:

"The Medicare Savings Programs are intended to improve access to health-care services for millions of low-income elderly Americans and to make them more secure financially. Program participation, however, remains relatively low.  In 1998, about half of people eligible for the QMB [Qualified Medicare Beneficiary] and SLMB [Specified Low-Income Medicare Beneficiary] programs were participating."  (p. 2)

"A reluctance to apply for benefits has been linked to a wariness of government pro-grams on the part of some.  Others say that they do not feel it is worth their time to apply for benefits."  (p. 2)

"Since 1998, the Centers for Medicare and Medicaid Services, or CMS (formerly the Health Care Financing Administration, or HCFA), has been engaged in a variety of activities designed to increase enrollment in the Medicare Savings Programs. "  (p. 3)

"States that have liberalized the asset test for Medicare Savings Programs can reduce the length of application forms and eliminate the requirements for applicants to provide documents related to assets.  States can also make it easier for people to complete the application process by minimizing verification requirements for applicants.  A few states already have implemented a 'self-declaration' policy.  This means that they accept applicants’ statements about their income and resources and do not require documentation."  (p. 4)

"Another point in the enrollment process where verification requirements can be eased is during re-enrollment.  One of the most effective ways to ensure that Medicare Savings Programs cover as many eligible people as possible is to keep people in the programs once they are enrolled.  Thus, easing the re-determination process is as important as easing the application process.  One technique is to use a 'passive' or 'automatic' re-determination process.  Program participants receive notices that ask them to verify that their income or resources have not changed.  When they sign and return the notices, they are re-enrolled in the program.  Or program participants simply receive a notice that their enrollment will continue unless they inform the Medicaid office that they no longer are eligible for benefits."  (p. 4)

"Several states already have liberalized or eliminated asset tests.  Others are considering it, but some policy-makers are reluctant to change rules related to asset tests because they fear that people who have low incomes but substantial assets will apply for benefits."  (p. 5)

"Outstationing is one technique that makes it possible for people to apply for benefits at locations other than the Medicaid or social services office.  When Medicaid eligibility workers are outstationed at community-based organizations, individuals who may have difficulty reaching Medicaid offices because of lack of transportation—for example, people who live in rural areas—may have a more accessible alternative.  In addition, others who are wary of 'government' or 'welfare' benefits also may be more willing to apply for benefits in locations other than social services offices."  (p. 5)

LTC Comment:  The recommendations from this report are an open invitation to fraud.  When you advertise a means-tested public assistance program, reach out to find potential eligibles, eliminate the requirement to provide proof of financial eligibility, and drop the requirement to re-confirm eligibility periodically, how can you possibly expect anything but rampant abuse of the program?  Decades of experience with Aid to Families with Dependent Children (AFDC) and with Medicaid nursing home benefits should have taught public officials by now that reasonable eligibility controls on public welfare programs are critical to insure their financial viability, fairness and effectiveness.