Maximizing Medicare and Economic Security for Low-Income/Duals Populations
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1 Maximizing Medicare and Economic Security for Low-Income/Duals Populations Brandy Bauer, NCOA Linda Nakagawa, NASUAD Marc Steinberg, CMS Improving the lives of 10 million older adults by National Council on Aging 1
2 Agenda A snapshot of Medicare beneficiaries MIPPA background & successes Finding vulnerable beneficiaries n4a outreach survey Promising practices Flexibilities provided to states to help duals Improving the lives of 10 million older adults by National Council on Aging 2
3 Medicare and Medicaid turned 50 in 2015! Source: Kaiser Family Foundation A Story of Medicare: A timeline Improving the lives of 10 million older adults by National Council on Aging 3
4 Medicare Beneficiary Household Income Improving the lives of 10 million older adults by 2020 Source: Kaiser Family Foundation A Primer on Medicare 2015 National Council on Aging 4
5 Two Programs That Can Help Part D Low Income Subsidy (LIS/Extra Help) For those with incomes up to 150% FPL and limited assets Pays Part D premiums Reduces costs of drugs at pharmacy to under $6.60 Medicare Savings Programs (MSPs) For those with incomes up to 135% FPL (may be higher in certain states) and limited assets Several types: QMB, SLMB, QI Pays Part B premium; QMB also pays Part B cost-sharing and Part A premiums (if applicable) No late enrollment penalties for those who qualify Improving the lives of 10 million older adults by National Council on Aging 5
6 Medicare Improvements for Patients and Providers Act (MIPPA) Successes & Legislation Improving the lives of 10 million older adults by National Council on Aging 6
7 Background on MIPPA Medicare Improvements for Patients and Providers Act (MIPPA) enacted by Congress in 2008 and funded: National Center for Benefits Outreach and Enrollment State Health Insurance Assistance Programs (SHIPs) Area Agencies on Aging (AAAs) Aging and Disability Resource Centers (ADRCs) Purpose Enroll low-income Medicare beneficiaries into LIS/Extra Help and MSPs Assist rural residents to enroll in Part D Improving the lives of 10 million older adults by National Council on Aging 7
8 Center for Benefits Access Key activities: Provide training and technical assistance (e.g., monthly webinars, conferences, and individualized support) and data collection and analysis Develop timely publications, including online bi-monthly newsletter (Benefits Alert), issue briefs, case studies, promising practices, etc. Use MIPPA funding to support Benefits Enrollment Centers (BECs) Improving the lives of 10 million older adults by National Council on Aging 8
9 MIPPA 2 & MIPPA 3 Affordable Care Act in 2010 funded MIPPA activities ( MIPPA 2 ) through mid-2012 Added promotion of new free Preventive Services under Medicare, including the Annual Wellness Visit One-year gap between the end of MIPPA 2 and MIPPA 3 funds (beginning late Sept. 2013) American Taxpayer Relief Act in 2013 funded MIPPA activities for an additional year Improving the lives of 10 million older adults by National Council on Aging 9
10 MIPPA 4 & MIPPA 5 Additional MIPPA 3 monies in Jan and amended by SGR ( doc fix ) law on April 1, 2014 Protecting Access to Medicare Act in 2014 funded MIPPA activities for an additional year Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) QI is permanent! Folks with incomes between % FPL and less than $7,280 in assets get help with Part B premiums Increased outreach and enrollment funds Improving the lives of 10 million older adults by National Council on Aging 10
11 National MIPPA Successes To Date Value of benefits applications submitted by MIPPA grantees * 2014 Total Value of Benefits MSP 31,594 84, ,998 99,232 24, , ,708 $661,488,341 LIS 46, , ,011 73,004 22,444 94, ,988 $1,855,952,000 Total 77, , , ,236 46, , ,696 $2,517,440,341 *One year gap in MIPPA funding meant that 2013 applications represent only one quarter of assistance Improving the lives of 10 million older adults by National Council on Aging 11
12 Finding Vulnerable Individuals Improving the lives of 10 million older adults by National Council on Aging 12
13 NCOA s Visualization Tools Show Medicare-eligible, low-income population: Enrolled in core benefits Self-reported disability/difficulty Limited English proficiency Eligible but missing LIS Native American Use of technology Improving the lives of 10 million older adults by National Council on Aging 13
14 Self-reported Difficulty/Disability Disability/difficulty grouped by: Ambulatory Cognitive Hearing Vision Self-care VA rated Improving the lives of 10 million older adults by National Council on Aging 14
15 Limited English Proficiency Improving the lives of 10 million older adults by National Council on Aging 15
16 Promising Practices Clearinghouse Finding people Outreach strategies Streamlining application process Follow-up and retention Improving the lives of 10 million older adults by National Council on Aging 16
17 MIPPA Outreach: How are we doing? Spring 2015 I&R Network Survey
18 2015 Survey: Methodology 2015 Network Survey of I&R Specialists in Aging and Disability: Conducted every other year Web-based survey instrument In the field March - April 2015 NASUAD collaborated with the National Council on Independent Living to encompass the CIL perspective NASUAD coordinated with leads in each state to ensure participation across the U.S.
19 2015 Survey: Respondent agency What type of agency do you work in? Page 19
20 2015 Survey: Respondent agency ADRC, 18.4% CIL, 10.3% AAA, 49.7% Other Non- Profit, 9.5% State Agency 12% Percent of Respondents N=358
21 2015 Survey: Screening Do I&R/A specialists in your agency screen for eligibility for Medicare lowincome subsidies? If yes, does your agency target older adults in its screening? If yes, Does your agency target younger individuals with disabilities in its screening? Page 21
22 2015 Survey: Targeted Screening Do I&R/A specialists in your agency screen for eligibility for Medicare low-income subsidies? Other, 8.0% No, 21.2% Yes, 70.8% Percent of Respondents N=325
23 2015 Survey: Targeted Screening If your agency screens for eligibility for Medicare low-income subsidies: Does your agency target older adults? No, 9.0% Yes, 91.0% Percent of Respondents N=222
24 2015 Survey: Targeted Screening If your agency screens for eligibility for Medicare low-income subsidies: Does your agency target younger individuals with disabilities? No, 43.7% Yes, 56.3% Percent of Respondents N=222
25 2015 Survey: Training Are I&R/A specialists in your agency given training on the Medicare lowincome subsidies? Page 25
26 2015 Survey: Training Are I&R/A specialists in your agency given training on the Medicare low-income subsidies? No, 16.8% Do not know, 5.1% Yes, 78.1% Percent of Respondents N=292
27 MIPPA Outreach: How can we improve? Promising Practices
28 Promising Practice #1 Insert MIPPA outreach into the internal framework of your organization. Provide all staff with access to screening information Ensure all staff are involved in screening efforts Page 28
29 Promising Practices Page 29
30 Promising Practices Page 30
31 Promising Practice #2 Go where the consumer is / where the consumer will be. Page 31
32 Promising Practices Senior Farmers' Market Nutrition Program (SFMNP) Page 32
33 Promising Practice #3 Rebrand the Medicare low-income subsidies to appeal to the consumer. Page 33
34 Promising Practices Medicare Boot Camp Page 34
35 Promising Practice #4 Think outside the box. Outreach stickers Pharmacy School partnerships Page 35
36 Promising Practices Page 36
37 State Strategies for Improving Enrollment and Retention for Medicare-Medicaid Enrollees Screen Medicaid beneficiaries for all categories of Medicaid, including Medicare Savings Programs Simplify income and asset rules Can disregard some or all assets Can disregard categories of income Simplify redeterminations Up to an annual (12 month) redetermination permitted Use available data sources for ex parte redetermination Reduce steps required for verification Improving the lives of 10 million older adults by National Council on Aging 37
38 Additional Reminders Since 2010, asset limits for Medicare Savings Programs are indexed to inflation Estate recovery eliminated for Medicare Savings Program benefits Medicare Part A buy-in agreement 14 states have not executed Part A buy-in agreements Improving the lives of 10 million older adults by National Council on Aging 38
39 Resources CMCS Informational Bulletin, Enrollment and Retention Flexibilities toe Better Serve Medicare-Eligible Medicaid Enrollees, January 23, 2015, available at Guidance/Downloads/CIB pdf NCOA, State Options to Streamline Eligibility for Medicare Savings Programs, February 2015, available at Improving the lives of 10 million older adults by National Council on Aging 39
40 Contact Us Presenters: Brandy Bauer Linda Nakagawa Marc Steinberg Improving the lives of 10 million older adults by National Council on Aging 40
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