Taking advantage.

Bill would automatically enroll QMBs and SLMBs

MANY SENIORS WHO QUALIFY FOR MEDICAID payment of their Medicare copayments and premiums aren't taking advantage of the coverage, prompting lawmakers to attempt to ensure participation in a safety net program for low-income elders. Representatives Pete Stark (D-Calif.), and Jim McDermott (D-Wash.) introduced in late May the Qualified Medicare Beneficiary Relief Act of 1999, which would require the Department of Health and Human Services to automatically enroll eligible Medicare recipients in the subsidy program.

Stark and McDermott introduced the bill, HR 1455, in response to an April General Accounting Office report citing low participation sates in the federally mandated program for low-income seniors known as Qualified Medicare Beneficiary (QMBs) and Specified Low-Income Medicare Beneficiary (SLMBs). The report found that 2.2 million Medicare beneficiaries are missing out on the available assistance.

So-called "quimbies," those with incomes at or below 100 percent of the poverty level (around $8,050 in 1998), qualify for Medicaid payment of their Medicare deductibles, copayments, and Part B premiums. Medicaid pays Part B premiums for "slimbies," who have incomes above 100 percent but under 120 percent of the federal poverty level. Under a Balanced Budget Act provision, two other categories of Medicare beneficiaries with incomes ranging from 120 to 175 percent of the federal poverty level receive some Medicaid assistance toward their Part B premiums through the year 2002.

Under Stark's and McDermott's proposed legislation, the Social Security Administration (SSA) would identify eligible Medicare beneficiaries based on IRS information. HHS would then send notices of enrollment to eligible recipients.

Many states require applicants to apply at more than one agency, including the state welfare office. "Most of the people who qualify for these programs haven't lived their life as poor or don't like to think of themselves that way," says JoAnn Lamphere, a senior policy advisor for the AARP's Public Policy Institute in Washington, D.C. "Part of the challenge is crafting a message that they have worked hard for the benefit and it's not welfare. The second challenge is to streamline the process."

The sheer complexity of the program, with its myriad definitions and acronyms, can confuse even seasoned government officials. For example, even though the federal government defines the categories of people who qualify for assistance, a QMB in one state might be a SLMB in another.

Within the past few years, HCFA has tried to improve participation in the QMB/SLMB program. The agency currently shares information about new Medicare beneficiaries' eligibility status for the programs with state Medicaid agencies and has encouraged states to take advantage of this process.