Eligibility

The CMS OMH report, “Disparities in Health Care in Medicare Advantage Associated with Dual Eligibility or Eligibility for a Low-Income Subsidy and Disability”, presents summary information on the performance of Medicare Advantage plans on specific measures of quality of health care reported in 2021, which corresponds to care received in 2020. Specifically, this report compares the quality of care for four groups of Medicare Advantage enrollees that are defined based on the combination of two characteristics: (1) dual eligibility for Medicare and Medicaid or eligibility for a Part D Low-Income Subsidy (LIS) and (2) disability...

The Council on Quality Leadership published a Q&A with ACL Acting Administrator and Assistant Secretary for Aging Alison Barkoff about the Home and Community Based Services (HCBS) settings rule in their latest newsletter. The Q&A session explores the settings rule, and how states can implement best practices throughout the transition period for implementation.

On March 15th, the Department of Health and Human Services, through CMS, announced 27 prescription drugs covered under Medicare Part B that may have lower beneficiary coinsurances. From April 1, 2023 through June 30, 2023, some people with Medicare who take these drugs may save between $2 and $390 per average dose, depending on the beneficiary’s coverage. Under the Inflation Reduction Act, signed into law in August 2022, drug companies that raise their drug prices faster than the rate of information are required to pay a rebate to Medicare. Starting April 1, 2023, Medicare beneficiaries may pay a lower coinsurance for certain Part B drugs if the drug’s price increased faster than the rate of inflation in a benchmark quarter.

KFF released a brief “What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access” (January 31, 2023) that the describes the major health-related COVID-19 emergency declarations made by the federal government since January 2020, and the flexibilities resulting from the declarations. The areas covered in the brief include coverage, costs, and payment for COVID-19 testing, treatments, and vaccines; Medicaid coverage and federal match rates; and telehealth, among other provisions. According to KFF, the list does not include all federal policy and regulatory provisions made in response to COVID-19 emergency declarations.

The KFF recently published two analyses on demographics and program enrollment and spending of Medicare and Medicaid dually eligible beneficiaries or dual eligibles. The article, “A Profile of Medicare-Medicaid Enrollees”, analyzes the demographic, socioeconomic, and health characteristics of dual eligibles using data from the 2020 Medicare Current Beneficiary Survey. The second article, “Enrollment and Spending Patterns Among Medicare-Medicaid Enrollees (Dual Eligibles)”, examines national and state-level data on enrollment and spending for Medicare-Medicaid enrollees. The authors used data from the 2019 and 2020 Medicare Beneficiary Summary Files and the 2019 Transformed Medicaid Statistical Information System for this analysis.

There are several changes that may affect SNAP household’s benefit amounts over the coming months. The temporary boost to SNAP benefits put in place during the COVID-19 pandemic, known as emergency allotments, will end nationwide after the February 2023 issuance. In addition, households that receive SNAP and Social Security benefits will see a decrease in their SNAP benefits because of the significant cost of living increase to Social Security benefits that took effect on Jan. 1, 2023.

This publication finds meaningful variation in disenrollment and churn across Medicaid beneficiary categories. Specifically, beneficiaries with Supplemental Security Income-related eligibility have low rates of disenrollment and high rates of reenrollments. In this research, Mathematica uses data from the Transformed Medicaid Statistical Information System Analytic File to examine rates of disenrollment, churn, and continuous coverage among categories of children and adult Medicaid beneficiaries whose eligibility is related to a disability.

On January 5, 2023 CMS released an Informational Bulletin providing further guidance on the Medicaid eligibility provisions in the recently-enacted Federal budget (Consolidated Appropriations Act of 2023). The CAA permits states to begin terminating Medicaid eligibility for current recipients on April 1, 2023 and provides gradually-decreased FMAP increases through December, 2023. This IB is the first in a series of written guidance from CMS on these provisions, focusing first on revised key due dates for certain state eligibility redetermination deliverables and activities.

The annual Medicare open enrollment period for Medicare Advantage and Part D plans ends Wednesday, December 7, 2022. To assist individuals who counsel Medicare clients, the National Council on Aging or NCOA developed a “Medicare Open Enrollment Toolkit”. The Toolkit includes many useful resources designed for professionals, advocates, caregivers, and/or older adults, including a fact sheet on changes to Medicare in 2023; information on Medicare Part A and Part B premiums and cost-sharing in 2023; a 2023 Medicare Part D cost-sharing chart; and other helpful information and guidance.

MACPAC has released its June 2022 Report to Congress on Medicaid and CHIP. The report recommends measures that Congress can take to better monitor access to care for Medicaid beneficiaries, improve the oversight and transparency of managed care directed payments, increase access to vaccines for adults enrolled in Medicaid, encourage the uptake of health information technology in behavioral health, and better integrate care for Medicaid and Medicare dual-eligibles. The commission also offers policy levers that states and the federal government can use to promote equity in Medicaid.