Medicare and Medicaid

The Qualified Medicare Beneficiary Program pays many out-of-pocket expenses for Medicare recipients whose incomes are not quite low enough to qualify them for regular Medicare benefits. The number of people enrolled has steadily increased since the program began in 1989, but a substantial portion of those eligible have yet to sign up--despite repeated efforts by government and advocacy groups to publicize the program. Many believe that people have not enrolled because of the perceived welfare stigma associated with means-tested programs and because of the complicated application process. Many also believe that authorizing the Social Security Administration (SSA) to make program eligibility determinations would help overcome these factors and boost enrollment. Although SSA might be able to increase enrollment, GAO believes that this concept should be tested before it is generally adopted. Finally, some state part A buy-in practices delay or preclude enrollment of Qualified Medicare Beneficiary Program and regular Medicaid beneficiaries in part A. This, in turn, can place some beneficiaries at a disadvantage relative to beneficiaries in other states.

GAO found that: (1) 2 million people eligible for the QMB program did not enroll in the program in 1991; (2) federal and state efforts to publicize the QMB program have not had a significant effect on the QMB enrollment rate; (3) beneficiaries have not enrolled in the QMB program because of the perceived stigma attached to such participation, the complicated application process, and the belief that the benefit is not worth much in monetary terms; (4) although many Medicaid officials believe that authorizing the Social Security Administration (SSA) to process QMB applications would increase enrollment, SSA has resisted the proposal because of insufficient resources; and (5) SSA should begin a pilot test for making QMB determinations before assuming the responsibility for QMB enrollment.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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