HCFA sets performance standards for enrolling seniors in Medicaid

Part of effort to expand coverage to dual-eligibles

States should increase their Medicaid enrollment of low-income Medicare beneficiaries by 4% in the upcoming year, according to new guidelines released for comment by the Health Care Financ ing Admi ni stration (HCFA).

The guidelines carry neither incentives or penalties, but are part of a much-needed effort to get Medicaid benefits to elderly patients who are entitled to them, says JoAnn Lamphere, DrPH, a senior policy advisor with the American Associa tion of Retired Persons in Washington, DC.

"There’s a whole series of steps they’re taking. Each individually isn’t much, but together it’s far more than HCFA has ever done," says Ms. Lamphere.

In addition to the two-year target enrollment initiative, HCFA has a variety of projects to help states increase Medicaid enrollment among the so-called dual-eligible population. HCFA also is working with a seven-state effort by the Social Security Administration to streamline the program’s outreach and enrollment efforts. (See related story, State Health Watch, June 1999, p. 8.)

Low-income Medicare beneficiaries are eligible for a wide variety of Medicaid programs that either expand health care coverage or provide assistance with Medicare’s cost-sharing requirements. A General Accounting Office report this spring estimated that the two largest programs, the Qualified Medicare Beneficiary program and the Specified Low-Income Medicare Beneficiary program, reach only about 57% of those eligible.

Because of the difficulty in developing reliable estimates of the number of potential enrollees by state, HCFA officials did not set state-specific targets for the first year, which ends in August 2000. Instead, HCFA expects progress among the states to be "commensurate" with the national target of 4%. Proposed baseline numbers, subject to revision, use estimated dual-eligible enrollment as of September 1998. (See chart depicting state-by-state dual-eligible enrollment, p. 8.)

HCFA officials relied on state-reported data for baseline enrollment, eschewing their own Medicaid data.

Contact Ms. Lamphere at (202) 434-3902. More information is available from HCFA at www.hcfa.gov/ medicaid/smd6799a.htm.