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Transcript 2004_SCI_MedicarePartD_summer

Meeting the Challenge of
Expanded Eligibility
Determination Requirements
for the Part D Subsidy
Laura Summer
Georgetown University Health Policy Institute
October 8, 2004
Simple is better
• A complex process poses barriers to
• The simpler the enrollment process, the
lower the administrative costs
• With less to explain, there is a greater
likelihood of providing effective
information, counseling, and assistance
Some different challenges
• Enrollment process differs for groups of
• A two-step process
• Many entities involved with the application
and enrollment process
[CMS, SSA, State Medicaid Programs, SPAPs, Managed
Care Plans Prescription Drug Plans (unknown), Aging,
Disability, and other Social Service Programs]
How to simplify enrollment
for full duals
• Consider how autoenrollment will work
• Insure that full duals can be identified
• Develop and modify information systems to
accommodate the transition
• Consider the proposed timeframe for
How to simplify enrollment
for MSPs
• Determine how to inform them of eligibility
and the need to enroll in a plan
• Assist with enrollment
• Be prepared to respond to questions
– Concerns about eligibility for other benefits,
estate recovery
– Confusion about the relationship between
Part D and MSP benefits
How to reduce confusion regarding
MSP and Part D subsidy benefits
• Secretary can opt to allow use of state MSP
• States can align MSP rules with subsidy
• SSA involvement in MSP eligibility
How to simplify enrollment
for others
• SPAP participants, Discount drug cardholders
• Other “unknown” low-income beneficiaries
• Use different approaches to reach the elderly,
those with disabilities
• Insure that approaches are appropriate
(culture, linguistics, literacy)
How to make the subsidy application
process as simple as possible
• Simple applications
• Simple definitions for resources
• Minimal requirements for verification
How to keep people enrolled
• Evidence that financial circumstances don’t
change substantially over time
• Use passive renewals
• Provide year-long continuous eligibility
Also for consideration
• Outcomes of current efforts to facilitate
enrollment for discount drug cards
• Utility of the CMS information tools now
and for the future
• Ongoing efforts to simplify enrollment for
the Medicare Savings Programs