May 1, 2002

To the Editor [of LTC Bullets]:

In your April 19, 2002 LTC Bullet entitled “The Welfare Rush,” your organization took issue with one of our publications from last year (Increasing Enrollment for the Medicare Savings Programs).  We would like to respond to two of the issues you raised in your email.

First, you assert that “most eligible people don’t bother to apply for [the Medicare Savings Programs].”  While it is true that less than half of those who are eligible for the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs actually participate in the programs, often this is due to personal and systemic barriers that potential applicants face, rather than a lack of interest in the programs.  Such barriers include: confusion about eligibility criteria (by both applicants and eligibility workers), communication barriers related to language, culture and physical disabilities, complex application processes, poor coordination among public programs, and most importantly, a lack of awareness of the existence of such programs.

Second, you object to the steps that many states have taken to streamline and improve the cumbersome enrollment and re-enrollment processes stating that these will lead to “rampant abuse of the program.”  Many of these improvements, such as shortened applications, self-declaration of assets, passive renewals, and outstationing workers, originated in Medicaid programs aimed at families and children, and were expanded to the Medicare Savings Programs.  There is little outcomes data available with regard to the impact of these changes for the Medicare Savings Programs.  However, a 2001 study commissioned by the Kaiser Commission on Medicaid and the Uninsured looked at the experiences of states that had eliminated the Medicaid assets test.  What they found was that the implementation of these changes yielded administrative cost savings for the program and did not increase the Medicaid eligibility error rate.  Similar results have been found through the Centers for Medicare and Medicaid Services’ Medicaid Eligibility Quality Control system which collects data on eligibility, beneficiary liability, and claims payments in order to prevent inappropriate spending due to erroneous eligibility determinations.

At the Center for Medicare Education, we share your concern with regard to the appropriate use of Medicaid resources by those who are truly in need.  And by no means were we issuing “an open invitation to commit fraud” in our brief as you implied.  Rather, the purpose of this brief was to increase awareness of these programs and describe some of the efforts that states and local organizations have taken to reach out to those who need and are eligible for these programs. What we do know with regard to the Medicare Savings Programs is that for people with low incomes, these programs can make a significant difference in their lives.

Thank you for the opportunity to set the record straight. 

Sincerely,

Marisa A. Scala

Executive Director

Center for Medicare Education

2519 Connecticut Avenue, NW

Washington, DC 20008-1520

202-508-1209 (phone)

202-783-4266 (fax)

mscala@medicareed.org