Medicare and Medicaid:

Many Eligible People Not Enrolled in Qualified Medicare Beneficiary Program

HEHS-94-52: Published: Jan 20, 1994. Publicly Released: Jan 25, 1994.

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Pursuant to a congressional request, GAO reviewed: (1) government efforts to publicize the Qualified Medicare Beneficiary (QMB) program; and (2) suggestions for increasing enrollment in QMB.

GAO found that: (1) 2 million people eligible for the QMB program did not enroll in the program in 1991; (2) federal and state efforts to publicize the QMB program have not had a significant effect on the QMB enrollment rate; (3) beneficiaries have not enrolled in the QMB program because of the perceived stigma attached to such participation, the complicated application process, and the belief that the benefit is not worth much in monetary terms; (4) although many Medicaid officials believe that authorizing the Social Security Administration (SSA) to process QMB applications would increase enrollment, SSA has resisted the proposal because of insufficient resources; and (5) SSA should begin a pilot test for making QMB determinations before assuming the responsibility for QMB enrollment.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: No proposals to implement the matter for consideration by the Congress have been introduced in the Congress. While the Balanced Budget Act of 1997 expanded the income level at which Medicaid can pay cost sharing for Medicare beneficiaries, the Congress did not act on the matter for consideration.

    Matter: Congress should consider authorizing a demonstration in selected states to determine the effect on QMB enrollment of having SSA process QMB applications. This demonstration should be designed to determine whether applicants are more likely to apply for QMB benefits at SSA rather than a Medicaid office and to identify any additional resources SSA would need if the process was adopted nationwide.

  2. Status: Closed - Not Implemented

    Comments: Although HCFA and the Congress have made numerous changes to Medicaid, no action was taken on this recommendation and no action is intended.

    Matter: To ensure that all eligible Medicaid beneficiaries who are also eligible for Medicare are enrolled in part A of Medicare, Congress may wish to consider requiring automatic part A buy-in for all QMB and regular Medicaid beneficiaries.


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