Low-Income Medicare Beneficiaries:

Further Outreach and Administrative Simplification Could Increase Enrollment

HEHS-99-61: Published: Apr 9, 1999. Publicly Released: Apr 16, 1999.

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William J. Scanlon
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Pursuant to a congressional request, GAO provided information on the level of enrollment in the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program, focusing on: (1) the demographic and socioeconomic characteristics of: (a) Medicare beneficiaries who enroll as a QMB or SLMB; and (b) Medicare beneficiaries who qualify for QMB or SLMB but do not enroll; (2) reasons why eligible beneficiaries are not enrolled; and (3) strategies to increase enrollment.

GAO noted that: (1) although enrollment in QMB and SLMB has increased since the programs were implemented, many potentially eligible Medicare beneficiaries are not enrolled in these programs; (2) in 1996, about 2.2 million of an estimated 5.1 million potentially eligible Medicare beneficiaries--about 43 percent--were not enrolled in either QMB or SLMB; (3) in general, the characteristics of QMB and SLMB enrollees are similar to individuals who are eligible but do not enroll, placing them among the most vulnerable Medicare beneficiaries; (4) in addition to having low income, these individuals tend to have health conditions affecting their capacity to perform various activities; (5) the groups differ in some respects, however, as beneficiaries who are eligible but not enrolled are more likely to be 80 years of age or older or to have no health insurance coverage other than Medicare; (6) GAO's analysis also indicates that QMB and SLMB enrollment can vary by specific demographic characteristics; (7) for example, enrollment is relatively high among beneficiaries who are disabled, in poor health, are members of minority groups, are separated, or have never married; (8) conversely, enrollment is lower for beneficiaries who are white, widowed, married, or have Medicare coverage because of age rather than disability; (9) advocates for low-income elderly and state officials GAO interviewed attributed persistently low QMB and SLMB enrollment to limited program awareness among beneficiaries and the programs' administrative complexity; (10) potentially eligible individuals are perceived to simply be unaware of these programs, their benefits, or their eligibility criteria; (11) also, low enrollment in these programs is thought to result from state cost-sharing obligations that limit states' incentives to notify and enroll eligible individuals; (12) recently, the Health Care Financing Administration (HCFA) and the Social Security Administration have initiated efforts aimed at identifying strategies for increasing QMB and SLMB enrollment; (13) HCFA has established a task force that is in the process of identifying targets for increased enrollment and strategies for reaching these goals; and (14) a number of states GAO contacted have taken steps to simplify their application and enrollment processes, and advocates and state officials who GAO interviewed suggest that expanded administrative simplification efforts in conjunction with more creative and targeted outreach could increase QMB and SLMB enrollment.

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