Field of Work: Increasing enrollment in Medicare Savings Programs.

Problem Synopsis: Medicare does not cover all medical costs. Beneficiaries are responsible for paying premiums, co-payments and deductibles, as well as for services not covered by Medicare. These costs can impose barriers to health care on people with limited incomes.

Medicare Savings Programs (MSPs) are designed to help Medicare recipients with limited income and resources cover some of these costs. Although some enrollees can save more than $2,000 per year, these programs have been undersubscribed throughout their history.

Synopsis of the Work: Under State Solutions: An Initiative to Improve Enrollment In Medicare Savings Programs (October 2001 through June 2008) organizations in each of five states—Louisiana, Minnesota, New Hampshire, New York and Pennsylvania—received grant support to undertake initiatives to boost MSP enrollment.

Key Results: The program yielded the following results:

• In the five grantee states, enrollment in the two largest Medicare Savings Programs increased from approximately 447,000 in August 2002 to 646,000 in November 2005, a 45 percent increase, compared with a 22 percent increase nationwide.
• The five grantee states used many approaches to identify and enroll new participants in Medicare Savings Programs. Strategies included modifying the programs' eligibility requirements, expanding outreach activities, simplifying the enrollment process, training staff and volunteers to conduct enrollment activities, forging partnerships, expanding enrollment opportunities, strengthening data collection and engaging state representatives to explore barriers to enrollment.
• State Solutions informed state and federal policy initiatives designed to maximize enrollment in Medicare Savings Programs, according to the program director. For example, the Medicare Payment Advisory Commission, an independent congressional agency that advises the U.S. Congress on Medicare, used findings from State Solutions grantees to support its March 2008 recommendations to Congress.

Key Recommendations: The following recommendations were made at a 2007 summit sponsored by the State Solutions national program office for state and federal policy-makers, private sector leaders and advocates:

• Simplify the administration of Medicare Savings Programs and the Part D Low-Income Subsidy program.
• Improve data sharing to ensure that beneficiaries are enrolled in the programs for which they are eligible.
• Engage the private sector more fully in efforts to enroll more beneficiaries.

Key Conclusions: According to national program office staff:

• Outreach efforts were most successful when they were targeted specifically to individuals who met the Medicare Savings Programs' eligibility criteria and when they included specific information about how and where to get help.
• Program operations can be improved by efforts to understand the MSP application process from the perspective of its beneficiaries.
• Policy changes that simplified the application and renewal processes helped boost enrollment.
• The need persists to reach and enroll low-income Medicare beneficiaries in the Medicare Savings Programs, as well as in the Low-Income Subsidy program available under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Medicare Part D).