Medicare Part D Low-Income Subsidy: Additional Efforts Would Help Social Security Improve Outreach and Measure Program Effects
GAO-07-555
Published: May 31, 2007. Publicly Released: Jun 20, 2007.
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Highlights
Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which created a Part D outpatient prescription drug benefit that enables Medicare beneficiaries to enroll in competing private drug coverage plans. The benefit also offers a subsidy administered by the Social Security Administration (SSA) to assist certain low-income Medicare beneficiaries with out-of-pocket costs. GAO was asked to review (1) SSA's progress in identifying and soliciting applications from individuals potentially eligible for the subsidy; (2) SSA's processes for making eligibility determinations, resolving appeals, and redetermining beneficiaries' eligibility; and (3) how the subsidy has affected SSA's workload and operations. To conduct this study, GAO reviewed the law, assessed subsidy data, and interviewed SSA and other officials.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Social Security Administration | To improve SSA's outreach efforts and its ability to measure the effectiveness of the Medicare Part D low-income subsidy application processes, the Commissioner of Social Security should establish specific performance goals and measures for SSA's outreach activities to provide the agency with a means to assess their effectiveness in soliciting applications from additional individuals who qualify for the subsidy, but have not yet applied. |
In its response to our report, SSA stated that it believed that its National Strategic Communications Plan serves as a comprehensive plan for its outreach efforts agency-wide, but that it would not be able to implement specific goals and measures due to the lack of reliable data on the eligible population. While we agreed that SSA's National Strategic Communications Plan serves as a comprehensive plan for describing the agency's outreach efforts, we stated that we did not believe that data on the potentially eligible subsidy population, while useful, were needed for SSA to establish specific performance goals and measures to assess the effectiveness of its outreach efforts. Although SSA has taken a number of actions to make more people aware of the subsidy, such as mailing a notice to approximately 6 million low-income Medicare beneficiaries informing them about the subsidy, it has not established the performance goals and measures we recommended.
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| Social Security Administration | To improve SSA's outreach efforts and its ability to measure the effectiveness of the Medicare Part D low-income subsidy application processes, the Commissioner of Social Security should direct staff to begin collecting data on the processing time for individual redetermination decisions, and establish performance standards for processing time for the appeals and redetermination decisions. |
SSA initially reported that the data it collects on processing time for the overall re-determination cycle provides adequate management controls for operational data. Also, while SSA stated that it had established a performance standard for assessing the timeliness of appeals, in a follow-up discussion with agency officials after receiving their comments, they told us that the goal did not exist, but that the agency planned to establish a goal of processing 75 percent of appeals in 60 days. However, in August 2009, SSA stated that it had established the performance goal for appeals, and that it had implemented a monthly processing goal report that captures data for the fiscal year. We believe that SSA's actions significantly address this recommendation.
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| Internal Revenue Service | The Commissioners of SSA and the Internal Revenue Service (IRS) should work together to assess the extent to which IRS tax data may help SSA to better target individuals who might qualify for the subsidy, possibly aiding SSA in better targeting its outreach efforts. This effort could also aid in developing more precise estimates of the eligible population and help to better inform the Congress on legislative proposals to allow IRS to share tax data with SSA to assist the agency with its outreach efforts. |
In it initial comments on our draft report in May 2007, SSA stated that it had begun discussions with IRS to evaluate how such a study might be designed. The IRS stated that it agrees that a test should be conducted and is willing to work with SSA in that effort, with the understanding that present law prohibits the IRS from sharing tax information as part of the test. In December 2008 issued, IRS issued the report from the study.
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| Social Security Administration | The Commissioners of SSA and the Internal Revenue Service (IRS) should work together to assess the extent to which IRS tax data may help SSA to better target individuals who might qualify for the subsidy, possibly aiding SSA in better targeting its outreach efforts. This effort could also aid in developing more precise estimates of the eligible population and help to better inform the Congress on legislative proposals to allow IRS to share tax data with SSA to assist the agency with its outreach efforts. |
In its initial comments on our draft report in May 2007, SSA stated that it had begun discussions with IRS to evaluate how such a study might be designed. In December 2008, IRS issued the report from this study.
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AppealsAppeals processBeneficiariesDisadvantaged personsEligibility determinationsHealth care programsInternal controlsMedicarePrescription drugsStrategic planningSubsidies