Benefits Checkup

The National Center for Benefits Outreach and Enrollment is compiling a database of promising practices related to benefits outreach and enrollment. We invite you to review these promising practices and cost-effective strategies that can strengthen your local or state efforts to increase access to benefits for seniors and younger adults with disabilities.

AREA OF FOCUS: OUTREACH AND CONNECTION, IDENTIFICATION OF ELIGIBLE POPULATIONS

Collaboration between State Agencies Yields Increased Enrollments

Arizona's State Health Insurance Counseling Program (SHIP) and the state Medicaid Agency (AHCCCS) worked together to conduct outreach and provide application assistance to persons who would likely qualify for Medicare Savings Programs and full Medicaid benefits. As a result, they substantially increased enrollments and learned that by working jointly they were able to successfully leverage each organization's knowledge and strengths.

Who was the target audience?
Medicare beneficiaries that would be eligible for Medicare Savings Programs and beneficiaries that would qualify for full Medicaid benefits.

What did they do?
With expanded Medicaid eligibility in 2001, AHCCCS took a more active role in outreach for Medicare Savings Programs and partnered with the SHIP to enroll eligible individuals. Their collaborative efforts included the following:

• AHCCCS provided training to SHIP counselors about the new, combined Medicare Savings Programs and AHCCCS application forms and appointed a SHIP liaison to trouble shoot issues, provide information on the status of applications and expedite application processing.
  
  
• The Medicaid agency sought input from the SHIP Coordinator on how to inform QMBs about the new eligibility limits for full Medicaid benefits and enroll those who wished to receive these benefits.
  
  
• AHCCCS mailed two notices, which the SHIP Coordinator helped to draft, to all of the QMBs in the state (about 8,000 individuals). The first notified the recipients: (1) of their ability to enroll in an AHCCCS plan and receive additional benefits, such as prescription drugs and transportation; (2) that they would automatically be enrolled in a Medicaid plan effective April 1, 2001, unless they called the Medicaid agency to decline such coverage; and (3) that they would be receiving a packet shortly containing information for them to chose a plan in their region. The follow-up mailing contained information about the available health plans, including contact numbers for information on participating providers. The letters stated that the Medicaid agency would assign them to health plan unless they selected a plan by March 27, 2001.

What was the result?
Following the mailings, SHIP and Medicaid officials handled several calls for assistance to explain the new options and assist beneficiaries in navigating their health plan choices. SHIP officials report that AHCCCS worked well with SHIP counselors to accommodate the special needs of beneficiaries and to resolve problems quickly, erring in favor of beneficiaries. For example, a number of persons, especially those who were ill or in the hospital during February and March, failed to select a health plan by the deadline and were assigned to Medicaid plans that were unsuitable for their health care needs (i.e., the local dialysis facility or hospital was not part of the plan network). In these cases, the Medicaid agency allowed plan changes after the deadline.

SHIP staff also reported that many Medicare beneficiaries required one-on-one assistance to complete the application process. Counseling was especially important for QMBs enrolled in Medicare HMOs, as such individuals needed to ensure that their primary care physician participated in both their Medicare and AHCCCS health plans to in order to coordinate their health care.

Most QMBs in Arizona chose to receive full Medicaid benefits in addition to their assistance with Medicare cost sharing. As of September 2001, only 885 people remained in QMB without full acute care. SHIP officials believed that most of these individuals did not enroll in an AHCCCS plan because they did not want to change providers, did not want to receive Medicaid or managed care, or did not qualify for full Medicaid benefits because they were working.

For more information:
K. Glaun, “Medicaid Programs To Assist Low Income Medicare Beneficiaries: Working Paper on Medicare Savings Programs in Arizona.” Kaiser Commission on Medicaid and the Uninsured (2002). To access the full text of this report, please click here .