Medicaid: Enrollment and Expenditures for Qualified Individual and Transitional Medical Assistance Programs

GAO-13-177R Published: Dec 12, 2012. Publicly Released: Jan 11, 2013.
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What GAO Found

The QI program enrolled about 426,000 individuals nationwide in 2009--the most recent year for which comprehensive enrollment data were available--with expenditures of about $431 million. While QI enrollment increased 30 percent from fiscal year 2006 to fiscal year 2009, program expenditures increased at a slightly faster rate, rising 39 percent during this time. On average, one quarter of individuals potentially eligible for the QI program were enrolled during fiscal years 2006 through 2009. However, the percentage of eligible individuals enrolled in the program climbed from 21 percent in fiscal year 2006 to 29 percent in fiscal year 2009. CMS does not have comprehensive national data on TMA enrollment and expenditures; the 41 states that had enrollment data reported that over 3.5 million individuals were enrolled in TMA in 2011, the most recent year for which complete enrollment data were reported by the highest number of states. Fewer states were able to report TMA expenditure data; however, 32 states reported TMA total expenditures of about $3.9 billion in 2011.

Why GAO Did This Study

Qualified Individual (QI) and Transitional Medical Assistance (TMA) are particular programs within Medicaid that are targeted to specific groups of low-income individuals. The QI program provides assistance to certain low-income Medicare beneficiaries by paying for their Medicare Part B premiums and is due to expire on December 31, 2012. The TMA program offers up to 1 year of additional Medicaid health insurance benefits for certain low-income families who would otherwise lose coverage. Under permanent provisions of the Social Security Act (SSA), Medicaid coverage continues for 4 months for families who would otherwise lose coverage due to an increase in earned income or hours of employment or increased child or spousal support. In addition, under a provision expiring on December 31, 2012, families who would otherwise lose Medicaid eligibility because of earned income or hours of employment, or the loss of a time-limited earnings disregard, receive at least 6, and up to 12, months of Medicaid coverage. In light of the approaching expiration of the QI program and certain TMA provisions, Congress asked us to provide more information on the programs' enrollment and expenditures to inform consideration of reauthorization. This report provides information about enrollment and expenditures in both the QI and TMA programs at the national and state levels.

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