The Centers for Medicare & Medicaid Services (CMS) finalized a rule Monday to streamline enrollment in Medicare Savings Programs (MSPs) with the aim of making coverage affordable for 860,000 more people.
Effective Nov. 17, the new CMS rule (PDF) is designed to simplify processes for individuals to enroll and retain eligibility in MSPs, better align enrollment into MSPs and reduce complexity of applications and reenrollment. Enrollment systems must comply by Oct. 1, 2024, while other provisions must be met by April 1, 2026.
Under the new final rule, many Supplemental Security Income (SSI) recipients will now be automatically enrolled into the Qualified Medicare Beneficiary eligibility group—a type of MSP coverage—which covers Medicare premiums and cost-sharing. CMS said that all Medicare-eligible individuals who receive SSI can receive MSP coverage, but many are not due to duplicative paperwork.
“Throughout my career, I have dedicated myself to ensuring that Americans have access to health insurance, so that they can survive and thrive,” said Department of Health and Human Services Secretary Xavier Becerra in a news release. “This rule brings us closer to that goal as we expand access and coverage for older Americans and people with disabilities.”
States will also use data from the Medicare Part D Low-Income Subsidy or “Extra Help” program. This program helps people with disabilities pay for prescription drugs living on a limited income. Starting in January, CMS is planning to expand provisions of President Joe Biden’s prescription drug law to expand eligibility for 300,000 people, according to the news release.
MSPs are run by state Medicaid programs. They cover Medicare Part A and B premiums and cost-sharing for more than 10 million older adults and people with disabilities, although millions of eligible people, or half, are still not enrolled. CMS projects that the rule will save people with disabilities nearly 19 million hours in paperwork each year and reduce state administrative burden by 2 million hours.
The rule acknowledges that states’ Medicaid unwinding has “disrupted routine eligibility and enrollment operations” and that this rule needs to promote continuity of coverage and care.
A second rule on policies related to Medicaid enrollment and eligibility, the Children’s Health Insurance Program and the Basic Health Program is expected to be released in 2024.
CMS anticipates the rule to cost around $26.16 billion over five years. The federal government will pay $10.67 billion, the states will pay $7.89 billion and Medicare will cover the last $7.6 billion.