Evaluation of Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) Programs: Volume 1
Low enrollment in the Medicare Savings Programs has been a source of long-standing concern. CMS’s 1999 initiative under the Government Performance and Results Act (GPRA)1 was to “improve access to care for elderly and disabled Medicare beneficiaries who do not have public or private supplemental insurance.” As part of its efforts to achieve this goal, CMS convened a group of federal and state representatives to create a national strategy for increasing enrollment in the Medicare Savings Programs. To support these efforts, CMS contracted with researchers to profile the characteristics of enrollees and those eligible but not enrolled, assess the effectiveness of state and federal outreach programs, and estimate the enrollment rate in the Medicare Savings Programs. To further this CMS GPRA goal, CMS contracted with RTI International to provide information on the effects of the Medicare Savings Programs, as well as factors that influence program participation. Our study addresses the following specific questions: • What factors drive the decision to enroll in the Medicare Savings Programs? • Do differences in outreach activities, enrollment processes, and eligibility criteria explain state variation in Medicare Savings Programs enrollment rates? • How long do beneficiaries remain enrolled in the Medicare Savings Programs? • What is the impact of enrollment on Medicare service use? • To what extent does adverse selection in the decision to enroll in the Medicare Savings Programs explain any observed differences in Medicare service use between enrollees and eligible nonenrollees? • What is the impact of enrollment on beneficiary out-of-pocket costs? Our study extends previous research on the Medicare Savings Programs by differentiating Medicare Savings Programs enrollees on their basis of entitlement and the benefits they receive. This distinction is critical to a full understanding of program enrollment and impacts. This report is one of several reports that were produced under RTI’s contract with CMS. Other reports include an evaluation of programs in states that received grant funding to promote outreach and enrollment in the Medicare Savings Programs (Hoover et al., 2002) and an evaluation of the impact of state limitations on Medicare cost-sharing payments on beneficiaries and providers (Mitchell and Haber, 2003).