HAP's monthly Conference Calls are an opportunity to partner with the SHIP network to improve the capacity of the SHIPs. Through the SHIP Shout Out feature, we answer the questions and comments raised during the SHIP Shout Out section of each month's call. We provide additional resources that we hope are useful in your work with beneficiaries. The SHIP Shout Out also is an opportunity for you, the SHIPs, to use your own expertise to share solutions for other SHIPs.
Next Steps: Strategies and Tools to Help Your QMB-Eligible Clients
Washington state is planning to change the ID for QMB-eligible beneficiaries from a coupon to an electronic swipe card. The coupon showed that beneficiaries were eligible for QMB. The new card does not indicate the level of assistance.
The caller mentioned her concern that health care providers in Washington may have more trouble determining the level of assistance for each beneficiary with an electronic swipe card. DSHS in Washington has a fact sheet to explain the change to the electronic card for Medicaid clients in that state. According to the fact sheet, providers must use one of five methods to verify their clients' eligibility. Accordingly, Washington's SHIP counselors who provide assistance to clients with Medicaid also will have to use one of these methods to verify their clients' eligibility.
If your state has made the transition from coupon to swipe card and you have solutions to share with Washington, please contact us. HAP can share your solutions with the SHIP network.
Although one caller from New York state had an issue with QMB identification, another caller responded that QMBs in New York can ask the local DSS office to provide a New York State benefits card to prove QMB status.
If you have solutions to share with New York, please contact us. HAP can share your solutions with the SHIP network.
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In California, many QMBs do not know that they are in QMB, so they do not know about the assistance.
The Center for Medicare Advocacy's Trish Nemore, who was the presenter on HAP's call, stated that much of the the federal government's effort involves increasing enrollment into Medicare Savings Programs. Therefore, less focus has been placed on post-enrollment. Considering the variety of experiences, it is likely that some clients do not know they are in QMB, and they will likely miss out on much of the benefit provided. This underscores the critical role that SHIPs and their partners play in educating enrollees about the benefit of an MSP. One step SHIPs can take is to partner with the local Medicaid office and share beneficiary education materials about the QMB program to increase knowledge about benefits.
Some QMBs do not know that they must show their QMB card at the providers' offices. When they don't use it, they are getting billed. The SHIP is putting a sticky note with instructions on clients' QMB cards .
As with the situation above, it is very important for beneficiaries to understand what enrollment in the QMB program means for them. This commenter offered one suggestion that SHIPs can do to help remind their QMB clients on how to use the card.
MIPPA provided SHIPs additional funds for outreach activities to find and enroll low-income beneficiaries into appropriate assistance programs. One caller suggested that SHIPs use this opportunity to explain to new QMBs what their benefit covers.
This suggestion is a good reminder about the opportunities that SHIP counselors have to educate their clients. While it is very important that beneficiaries are enrolled into assistance programs for which they qualify, it is equally important that these beneficiaries understand what they have to do to use that assistance. Based on the comments and questions above, it is clear that some, if not many, people with QMB do not understand how that program works or that they are exempt from Medicare cost sharing. With MIPPA funding offering increased opportunity to reach new QMB-eligible beneficiaries, the role for education increases accordingly.
If you have additional ideas or solutions to share with other SHIPs, please contact us. HAP can share your solutions with the SHIP network.
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One commenter shared that some beneficiaries eligible for QMB were told that they cannot join a Part D plan until the Annual Enrollment Period this fall.
CMS's PDP Enrollment Guidance addresses this topic:
20.3.2 – SEP for Dual-eligible Individuals or Individuals Who Lose Their Dual-eligibility
There is an SEP for individuals who are entitled to Medicare Part A and/or Part B and receive any type of assistance from the Title XIX (Medicaid) program. This also includes individuals often referred to as ―partial duals‖ who receive cost sharing assistance under Medicaid (e.g., QMB, SLMB, etc). This SEP begins the month the individual becomes dually-eligible and exists as long as s/he receives Medicaid benefits. This SEP allows an individual to enroll in, or disenroll from, a Part D plan.
If you have clients who have been misinformed about their enrollment rights as QMBs, we encourage you to follow the established protocol in your state for reporting issues, whether it is following up with your coordinator, state director, or CMS.
In New York, the Medicaid agency may not understand the the many roles that the SHIP (HICAP) program can play, including their role in issues related to QMB.
HAP has developed a public education document — SHIPs Helping Medicare Consumers — to assist SHIPs in communicating the complex role they play in helping various beneficiary populations. We invite you to use this tool when discussing the roles and responsibilities of the SHIP, according to your state's established protocols for community education.
In Colorado, QMBs avoid going to local physicians and instead get their care from health clinics.
We are interested in hearing more about this issue from SHIPs across the country. Are QMB-eligible beneficiaries staying away from Medicare participating providers in order to avoid Medicare cost sharing? If you have clients for which this is the case, please contact us. HAP can share your solutions with the SHIP network.
EPIC (New York's SPAP) is not getting regular updated files of the Part D enrollment status of EPIC members. This is causing problems for the SHIP in that it requires manual updates of enrollment records which takes a long time.
HAP will follow up with CMS to find out more about the data transfer processes among the state, CMS, and SPAPs. In the meantime, if you have solutions to share, please contact us. HAP can share your solutions with the SHIP network.
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