Social Service Coordinators (SSC) is transitioning to:
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SSC aids tens of thousands of older adults and disabled individuals every year through applications for Medicare Savings Programs (MSPs), Extra Help (Low Income Subsidy) and other community assistance programs.
Participating in MSPs improves the financial well-being of low-income individuals, reduces financial barriers to health care and can lead to better health outcomes for eligible Medicare beneficiaries. Yet less than one in three eligible low-income persons is receiving benefits.
Rates of enrollment in the MSPs are well below those of other means-tested benefit programs. The Congressional Budget Office estimates that only 33 percent of eligible people are participating in the Qualified Medicare Beneficiary (QMB) program, and that the participation rate in the Specified Low-Income Medicare Beneficiary (SLMB) program is only 13 percent (these figures exclude people who are eligible for full Medicaid benefits). In comparison, participation rates are estimated to be 75 percent in the earned income tax credit, 66 percent to 73 percent for Supplemental Security Income, and 66 percent to 70 percent for Medicaid (as per the National Council on Aging).
Why do so many eligible people fail to sign up for the Medicare Savings Programs (MSPs)?
In 2003, the National Academy of Social Insurance (NASI) convened a study panel to identify ways to increase the number of people enrolled in MSPs. The panel identified several barriers to enrollment:
Lack of Awareness. Not knowing that the Medicare Savings Programs exist is the most significant barrier to enrollment. Seventy-nine percent of non-enrolled eligible people have never heard of the Medicare Savings Programs. Those who are aware are often unsure what agencies to turn to - some programs are administered by the federal government while other programs are administered by state or local governments.
Hard-to-Reach Population. Many eligible individuals can be difficult to reach or communicate with because, as older adults, they may have difficulty seeing or hearing, or lack necessary transportation or because English is not their primary language.
Burdensome Application Process. In addition to completing a lengthy form, applicants must usually provide substantial documentation. As a result, two-thirds of enrollees need help with the application.
Connection to Welfare. Many people are reluctant to apply for benefits at a Medicaid office—still a requirement in many states.
Asset Reporting. Many potential beneficiaries do not apply because they incorrectly assume that they have too many assets to qualify or fear losing their estate.
How can we overcome the barriers?
In 2004, the Access to Benefits Coalition conducted a study to identify the best practices for enrolling seniors and younger persons with disabilities in prescription savings and other public benefits programs. The study found that a key factor for increasing success was the use of a phone-based enrollment process that utilized technology such as online eligibility tools.
The study also found that outreach results could be enhanced by carefully planning the method, format and frequency of contacts to a steady volume of “Qualified” leads (i.e., those most likely to be eligible identified at the beginning the outreach process), by screening for multiple benefits simultaneously, and by providing one-on-one assistance throughout the enrollment process. SSC employs all these practices.
What is SSC doing?
Since our inception in 2000, SSC has sent over 13,000,000 letters to Medicare beneficiaries informing them about the qualifications for and benefits of the Medicare Savings Programs. Our member mailing materials have evolved over the last several years as we learned what works best with this population and as the Centers for Medicare & Medicaid Services’ (CMS) position on the required content changed.
In 2005, SSC’s standard set of member mailing materials was accepted as a national template by the CMS Product Consistency Team. Now, only the variable, state-specific information (for example, MSP income/asset limits, State Medicaid Agency Name, State SHIP Name and Telephone Number, etc.) is included with the CMS filing for review. As always, situation-specific documents are created and submitted for a full CMS review by the CMS Plan Manager.
SSC's task management system provides the automation solution that optimizes our efficiency. Our associates have the needed application forms readily accessible in electronic formats. In 2005 alone our outreach and advocacy staff filed tens of thousands of applications for governmental assistance on behalf of low income and disabled individuals. As SSC moves to document imaging, we gain the ability to transmit entire application packets (i.e., official forms and eligibility verifications), electronically; avoiding potential mail delays. We welcome state Medicaid administration requests to pilot projects that allow them to accept submissions of applications and related eligibility verifications electronically.
When it comes to navigating the complexities of eligibility policies, regulations, procedures, and forms, there is no substitute for experience. SSC has recruited and trained a highly skilled staff of over 200 associates, drawn from various social service agencies. For those state Medicaid Administrations that have put them on-line, our Outreach Coordinators have instant access to their Aged, Blind & Disabled Medicaid eligibility policies (our State ABD Manual Library is full of hard copies of the other states’ versions – complete with frequent updates).
Our staff is proficient at initiating and maintaining an open, productive relationship with our clients and government agencies alike throughout the entire application process. If an applicant needs assistance to obtain a necessary document, our Outreach staff is there to help - in some cases a Field Coordinator is even available to go to the client’s home and perform the interview in-person.
SSC’s task management system reminds Outreach staff to follow-up with customers who have not returned the Outreach package within a period of time. Experience has shown that the majority of our customers need longer than the federally-specified 45-day timeframe for Medicaid’s processing MSP applications to gather all the required documents needed to prove eligibility. Because the application processing timeframe starts when the application is received at the Medicaid office, unnecessary denials (and the extra work created by them for the Medicaid Eligibility Workers) can be avoided.
Medicaid offices should expect to see SSC’s applications arrive virtually complete; with all the required forms and needed verifications. We train our Outreach Coordinators to use interviewing techniques that elicit complete responses. While SSC has a thorough Quality Assurance process through which all application packets are processed before submission to the state Medicaid agency, state and county workers should please note that SSC does not have access to any previous applications or tape match data.