Friday,
April 19, 2002
Baltimore,
Maryland--
***
New content just posted in the donor-only zone of www.centerltc.org includes
these "LTC Week in Review" items:
LTC
E-Alert #112--Fit for Life
LTC
E-Alert #113--On Age and Alcohol
LTC
E-Alert #114--Double Downs on LTC
LTC
E-Alert #115--Don't Count on VA Benefits
LTC
E-Alert #116--Advocates vs. Industry and Government on NH Feeding Assistants
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LTC
BULLET: THE WELFARE RUSH
What
if you implemented some wonderful new welfare programs, but most eligible people
didn't bother to apply for them? Wouldn't
you go back to the drawing board and design something the public needs and
wants? Not if you're the Center for
Medicare Education (http://www.medicareed.org/).
Their answer is to advertise the shunned programs widely, to perform
"outreach" in order to locate people financially eligible to apply,
and then to reduce or eliminate barriers to participation, such as the
requirement that applicants provide proof of financial eligibility.
The
"Medicare Savings Programs," also known as Medicare Assistance
Programs or Medicaid Buy-in Programs, are designed to provide financial
assistance to low and moderate income Medicare beneficiaries who do not qualify
for the full Medicaid benefits package. In
other words, these programs use Medicaid (i.e. public welfare) money to pay the
Medicare premiums, co-insurance, and deductibles of "dual eligibles"
(people who qualify for both Medicare and for these special Medicaid-financed
programs.) You can get the details
about all four programs from the Center for Medicare Education's "issue
brief" on the subject titled "Increasing Enrollment for the Medicare
Savings Programs" (http://www.medicareed.org/pdfs/papers48.pdf).
Our focus here is on the lack of voluntary public participation in the
programs and on the insistence of senior advocates that potential applicants
must be somehow tracked down and signed up.
Here
are some excerpts from the report followed by our "LTC Comment"
analyzing their meaning:
"The
Medicare Savings Programs are intended to improve access to health-care services
for millions of low-income elderly Americans and to make them more secure
financially. Program participation, however, remains relatively low.
In 1998, about half of people eligible for the QMB [Qualified Medicare
Beneficiary] and SLMB [Specified Low-Income Medicare Beneficiary] programs were
participating." (p. 2)
"A
reluctance to apply for benefits has been linked to a wariness of government
pro-grams on the part of some. Others
say that they do not feel it is worth their time to apply for benefits."
(p. 2)
"Since
1998, the Centers for Medicare and Medicaid Services, or CMS (formerly the
Health Care Financing Administration, or HCFA), has been engaged in a variety of
activities designed to increase enrollment in the Medicare Savings Programs.
" (p. 3)
"States
that have liberalized the asset test for Medicare Savings Programs can reduce
the length of application forms and eliminate the requirements for applicants to
provide documents related to assets. States
can also make it easier for people to complete the application process by
minimizing verification requirements for applicants.
A few states already have implemented a 'self-declaration' policy.
This means that they accept applicants’ statements about their income
and resources and do not require documentation."
(p. 4)
"Another
point in the enrollment process where verification requirements can be eased is
during re-enrollment. One of the
most effective ways to ensure that Medicare Savings Programs cover as many
eligible people as possible is to keep people in the programs once they are
enrolled. Thus, easing the
re-determination process is as important as easing the application process.
One technique is to use a 'passive' or 'automatic' re-determination
process. Program participants receive notices that ask them to verify
that their income or resources have not changed.
When they sign and return the notices, they are re-enrolled in the
program. Or program participants
simply receive a notice that their enrollment will continue unless they inform
the Medicaid office that they no longer are eligible for benefits."
(p. 4)
"Several
states already have liberalized or eliminated asset tests.
Others are considering it, but some policy-makers are reluctant to change
rules related to asset tests because they fear that people who have low incomes
but substantial assets will apply for benefits."
(p. 5)
"Outstationing
is one technique that makes it possible for people to apply for benefits at
locations other than the Medicaid or social services office.
When Medicaid eligibility workers are outstationed at community-based
organizations, individuals who may have difficulty reaching Medicaid offices
because of lack of transportation—for example, people who live in rural
areas—may have a more accessible alternative.
In addition, others who are wary of 'government' or 'welfare' benefits
also may be more willing to apply for benefits in locations other than social
services offices." (p. 5)
LTC
Comment: The recommendations from
this report are an open invitation to fraud.
When you advertise a means-tested public assistance program, reach out to
find potential eligibles, eliminate the requirement to provide proof of
financial eligibility, and drop the requirement to re-confirm eligibility
periodically, how can you possibly expect anything but rampant abuse of the
program? Decades of experience with
Aid to Families with Dependent Children (AFDC) and with Medicaid nursing home
benefits should have taught public officials by now that reasonable eligibility
controls on public welfare programs are critical to insure their financial
viability, fairness and effectiveness.