The final rule, Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment, is scheduled to be published in the Federal Register on September 21. The provisions within the rule will make coverage more affordable for 860,000 people.
“This final rule will help hundreds of thousands of people access health care while also freeing up already limited income for food, housing, and other life necessities,” said CMS Administrator Chiquita Brooks-LaSure in the announcement.
CMS officials said the changes will save older adults and people with disabilities nearly 19 million hours in paperwork each year and reduce state administrative burden by over two million hours annually. The final rule, combined with the President’s prescription drug law, will help an estimated 1.2 million older adults and people with disabilities with limited income afford their Medicare coverage and health care costs.
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MSPs, which are run by state Medicaid programs, currently cover Medicare premiums and, in most cases, cost-sharing for more than 10 million older adults and people with disabilities who also have limited incomes. Through the MSPs, Medicaid pays Medicare Part B premiums each month for over 10 million individuals and Part A premiums for over 700,000 individuals.
Although MSPs provide vital links to coverage and care, only half of eligible people are enrolled in the MSPs, in part due to cumbersome application and verification processes. The final rule now simplifies these processes. In a fact sheet, CMS outlined the impact of the final rule, noting it:
- Reduces red tape by eliminating duplicative paperwork and leverages data from other programs.
- Reduces costs for individuals by lowering Medicare premiums and out-of-pocket costs for an estimated 860,000 eligible people by helping them to enroll in the MSPs. The current MSP verification processes impose a substantial burden on individuals because they must gather extensive paperwork and mail copies to states. The final rule places emphasis on states reviewing electronic sources and accepting self-attestation, saving older adults and people with disabilities over $87 million on transportation, copying, postage, and other related costs.
- Streamlines application and enrollment by automatically enrolling certain individuals into the Qualified Medicare Beneficiary (QMB) group and better leveraging Medicare Part D Low Income Subsidy (LIS) data:
- Supplemental Security Income (SSI) recipients: CMS said that all Medicare-eligible individuals who receive SSI are financially eligible for MSPs, but many are not enrolled because of burdensome and duplicative paperwork. CMS estimates that in 2022, more than 500,000 Medicare-eligible SSI recipients (over 16 percent) are not enrolled as QMBs. Under the final rule, many SSI recipients will now be enrolled automatically into QMBs, which covers Medicare premiums and cost sharing.
- LIS “leads” from Medicare Part D: Both the MSP and Medicare Part D LIS or “Extra Help” programs assist individuals who have limited incomes in accessing eligible Medicare benefits. Although they have similar income and resource eligibility criteria, many people enrolled in the LIS program are not enrolled in an MSP, despite likely being eligible. The final rule streamlines the enrollment process from LIS to MSP by requiring states to use the LIS information both as an application for MSP and when making an MSP eligibility determination. CMS said the provisions will reduce documentation burden and streamline enrollment of eligible LIS recipients into MSPs.
- Reduces costs of prescription drugs: Enrollment in the MSPs automatically grants enrollment into the Medicare Part D LIS program. This will help further the Administration’s goals of reducing out-of-pocket costs for drugs under Medicare Part D. Concurrently, CMS and the Social Security Administration are preparing to implement provisions of the President’s prescription drug law that expands eligibility for the full LIS benefit, which will allow an estimated 300,000 people to have lower drug costs starting January 1, 2024. CMS said that together, the final rule and the drug law’s expansion of the LIS program, will make Medicare more affordable for seniors and people with disabilities.
- Protects vulnerable individuals from Medicare premiums and cost-sharing as early as possible: Most individuals enrolled in Medicare qualify for Part A without paying a premium, but some individuals have not worked enough hours to qualify for premium-free Part A. Individuals who lack premium-free Part A are more likely to have worked in the informal economy in low-wage jobs. The final rule clarifies that individuals who owe a premium for Part A and live in certain states can get QMB coverage of Parts A and B premiums and cost-sharing on the earliest possible date.