State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus...
Transcript of State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus...
Julie CarterFederal Policy Associate
State-Specific Processes for
Expansion Medicaid-to-Medicare
Transitions
Emily BalkanSenior Policy & Client Services Associate
© 2017 Medicare Rights CenterPage 2
About Medicare Rights
National helpline: Around 20,000 questions
answered per year. Affordability, denials, and
enrollment confusion are perennial problems
Education: Uses helpline information to develop
educational programming serving millions
annually
Policy: Regulatory and legislative comments,
education of policymakers, voice for consumers in
Washington, DC and New York
Introduction
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Some introductory items
Who is in the room?
Raise your hand if you…
Introduction
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The project
Still in progress!
Medicare Rights is working in partnership with
and with funding from NCOA
We are conducting a survey of states that are
offering Medicaid to the adult group (expansion
Medicaid) as a result of the Affordable Care Act
Introduction
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About Medicaid expansion
31 states, plus DC, have expanded Medicaid
eligibility to adults 19-64 under 138% of the
Federal Poverty line ($16,643 in most states)
A person cannot be dually enrolled in expansion
Medicaid and Medicare
Those who become eligible for Medicare must
transition from one program to another
Introduction
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Project goals
Learn how (and if) states help Medicaid
expansion enrollees transition to other Medicaid
programs, Medicare, and MSPs
Look for best practices among the various states
(stumble across some worst practices too)
Project
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More goals
Spot themes and trends in states
What are states trying to do?
What have they identified as goals?
Identify common barriers to successful help with
transitions
Project
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What have we done?
Conducted initial online research into how and if
states post information on Medicaid, Medicare,
and MSPs
Developed a short questionnaire through an
iterative process with feedback from CMS, NCOA,
and advocates
Launched the survey and interview process
Continue to look for participants. Join us!
Project
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Who has responded?
Targeting all 31 expansion states, plus DC
People in 18 states have responded so far
State employees, SHIP employees, and
advocates have all provided their unique
perspectives
Project
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Common themes: Identification
Most states do try to notify those who are
approaching Medicare eligibility that they will
have to take some action Example: Washington sends a notice approximately
two months before the 65th birthday month
Identifying people who are becoming eligible
following their 24-month SSDI waiting period is a
challenge for most states
Common themes
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Common themes: Computers
Computer systems can help states identify and
contact those who are approaching Medicare
eligibility, but they can also create chaos and add
another frustrating layer if not done right Example: a computer system that must be overridden
by the system developer on a case-by-case basis in
order to get appropriate enrollment
Common themes
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Common themes: Staffing
Staffing cuts and lack of training can exacerbate
any other systemic issues and interfere with
beneficiaries being able to get answers to urgent
questions Example: if a computer gives a nonsensical output
such as flagging a 90-year-old woman as pregnant,
leading to her loss of benefits for failing to submit
proper documentation
Common themes
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Common themes: Knowledge gaps
Knowledge gaps create access problems Example: beneficiaries who are unaware of the
existence of MSPs who reject Medicare Part B
because of the expense
Little outreach and little or no information about
Medicare or MSPs on their websites Example: If someone doesn’t know there is a deadline
to enroll, or potential penalties or potential help, they
might not think to look up the information
Common themes
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Common themes: Communication
Incomplete, incorrect, or confusing notice or
application language and design Example: an MSP application where applicants must
handwrite in that they are requesting an MSP
In some cases, even state workers do not
understand the notices Example: a notice that uses several different terms that
all refer to MSPs, but caseworkers only know one of
the terms
Common themes
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Good practices: Notice & eligibility
Send notices to people approaching Medicare
eligibility, including an appeal form Examples: NY, OH, CA
Automatically determine MSP eligibility Example: CA (at least some counties)
Good practices
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Good practices: Communication
Good, easy-to-find and self-explanatory
information available on their websites that
explains the timelines for Medicare, interactions
between various insurance options, etc. Example: Washington
https://www.insurance.wa.gov/your-
insurance/medicare/
Good practices
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Good practices: Communication
From Washington’s Medicare site:
Good practices
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Areas of concern
Most interview subjects did not feel their states
were doing a good job preparing Medicaid
enrollees to transition to Medicare, or getting
eligible Medicare enrollees into MSPs
Staffing continues to fall in most areas
Notices and applications need significant work
Coordination between federal and state entities is
not always good
Conclusion
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Big picture
If states do not view this area as one that is of
primary concern to them, they may not be willing
to take steps to ease transitions, even when
failing to do so may cause harm to beneficiaries,
headaches for the state, and hassles for
caseworkers and advocates
Conclusion
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Get involved
Interested in taking part in this research? We welcome your
involvement
Come talk with us!
Complete our survey
https://www.surveymonkey.com/r/5FQ2W2B
Or contact Julie Carter: [email protected]
Conclusion
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Stay involved
Visit us at www.medicarerights.org
Advocate at www.medicarerights.org/protect
Call our helpline at 1-800-333-4114
Sign up for Medicare Watch
Like us on Facebook
Follow @medicarerights
Conclusion