Under these  programs, state Medicaid programs pay enrolled beneficiaries’ Medicare  premiums. SSA Is Conducting an Annual Outreach Effort Targeted to Low-Income Medicare Beneficiaries

In response to BIPA, SSA is conducting an annual outreach effort to help  increase enrollment in Medicare savings programs. This outreach consists  of a nationwide mailing campaign and data sharing with the states. Letters were targeted to beneficiaries whose  incomes from Social Security and certain other federal sources were less  than 135 percent of the federal poverty level (FPL). In addition to sending letters to potentially eligible low-income Medicare  beneficiaries, in 2002 SSA provided all but six states with an electronic  data file containing the names of all beneficiaries to whom it had sent  letters in that state. For the June through October 2003 mailing, SSA sent a second round of  letters to about 4.3 million potentially eligible low-income Medicare  beneficiaries nationwide whom its records indicated might have met the  QMB, SLMB, and QI income eligibility criteria and were not currently  enrolled in Medicare savings programs. For example,  beneficiaries less than 65 years old, persons with disabilities, racial and  ethnic minorities, and residents in southern states experienced larger  additional increases in enrollment. More than 74,000 Additional Beneficiaries Enrolled in Medicare Savings Programs Following SSA’s 2002 Mailing

On the basis of our analysis of SSA’s Master Beneficiary Record (MBR),  we estimate that, of the 16.4 million SSA letter recipients in 2002, an  additional 74,000 beneficiaries (0.5 percent of letter recipients) enrolled in  Medicare savings programs than would have likely enrolled without the  mailing. Certain States and Demographic Groups Had Higher Enrollment Rates Following SSA’s Outreach

Across the United States, letter recipients residing in the southern states  had a 0.6 percent additional increase in enrollment following SSA’s  mailing. Enrollment Increases Varied among Selected States We Reviewed, with Several Reporting Increased Calls and Applications Concurrent with SSA Mailing

The percentage of additional letter recipients newly enrolling in Medicare  savings programs following SSA’s mailings varied significantly among the  six states we reviewed. Among these six states, enrollment increases  ranged from 0.3 to 2.9 percent. The varying effects on enrollment by state can be attributed to several  factors, including, the share of eligible beneficiaries already enrolled in  Medicare savings programs prior to the outreach, a state’s ability to handle  increased phone calls and applications, and a state’s income and asset  limits. Concurrent with SSA’s mailing, each of the states we reviewed reported  that the state or other stakeholders conducted additional outreach. SSA also noted that improvements in state enrollment  processes could further increase enrollment. Appendix I: Methodology

To determine what outreach the Social Security Administration (SSA)  conducted in response to the statutory requirement, we obtained and  reviewed copies of SSA documents, including sample 2002 and 2003  outreach letters and data on the number of letters sent to eligible Medicare  beneficiaries in each state, as well as reports prepared by the Centers for  Medicare & Medicaid Services (CMS) related to the Medicare savings  program. To determine how enrollment changed following SSA’s outreach, we  analyzed records from SSA’s Master Beneficiary Record (MBR)—a  database that contains the administrative records of Social Security  beneficiaries, including payments for Medicare premiums—and CMS’s  national enrollment data for the Medicare savings programs. To determine how additional enrollment in the programs changed in  selected states following SSA’s outreach and what outreach efforts these  states undertook, we interviewed Medicaid officials in six states— Alabama, California, Louisiana, New York, Pennsylvania, and Washington. In addition,  we obtained information from each state to the extent available on its  involvement with the SSA mailing, the state’s specific eligibility criteria for  its Medicare savings program, outreach efforts conducted by the state to  low-income Medicare beneficiaries, and state data on call and application  volume before, during, and after the SSA outreach.
Why GAO Did This Study

To assist low-income beneficiaries with their share of premiums and other out-of-pocket costs associated with Medicare, Congress has created four Medicare savings programs. Historic low enrollment in these programs has been attributed to several factors, including lack of awareness about the programs, and cumbersome eligibility determination and enrollment processes through state Medicaid programs. Concerned about this low enrollment, Congress passed legislation as part of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) requiring the Social Security Administration (SSA) to notify low-income Medicare beneficiaries of their potential eligibility for Medicare savings programs. The statute also required GAO to study the impact of SSA's outreach effort. GAO examined what outreach SSA undertook to increase enrollment, how enrollment changed following SSA's 2002 outreach, and how enrollment changed in selected states following SSA's outreach and what additional outreach efforts these states undertook. GAO reviewed information obtained from SSA and the Centers for Medicare & Medicaid Services (CMS), analyzed enrollment data provided by SSA and CMS, and interviewed officials in and obtained data from six selected states (Alabama, California, Louisiana, New York, Pennsylvania, and Washington).

What GAO Found

In response to a statutory requirement, SSA is carrying out an annual outreach effort to help increase enrollment in Medicare savings programs. This outreach effort consists of mailing letters to potentially eligible lowincome beneficiaries nationwide as well as sharing data with states to assist with their supplemental outreach efforts. In 2002, SSA sent 16.4 million letters to low-income Medicare beneficiaries whose incomes from Social Security and certain other federal sources met the income eligibility criteria for Medicare savings programs. The 2002 letters provided eligibility criteria for programs in the beneficiary's home state and urged beneficiaries interested in enrolling to call a state telephone number provided. In addition to sending these letters, SSA provided states with a data file containing information on the beneficiaries to whom it sent letters. In 2003, SSA sent another 4.3 million letters to potentially eligible beneficiaries, and indicated that it intends to repeat the outreach mailing annually to newly eligible beneficiaries and a portion of prior letter recipients. Following SSA's outreach efforts in 2002, GAO estimated that more than 74,000 additional eligible beneficiaries enrolled in Medicare savings programs, 0.5 percent of all 2002 letter recipients, than would have likely enrolled without the letter. CMS enrollment data also showed that growth in Medicare savings programs enrollment for the year following SSA's mailing was nearly double that for each of the 3 prior years. Of the 74,000 additional enrollees, certain states and demographic groups had somewhat larger increases in enrollment than other groups. The highest additional enrollment increase was in Alabama, where 2.9 percent of letter recipients enrolled, followed by Delaware at 2.0 percent. Beneficiaries less than 65 years old, persons with disabilities, racial and ethnic minorities, and residents in southern states also had higher enrollment rates than other groups. The percentage of letter recipients newly enrolling in Medicare savings programs following SSA's 2002 mailing ranged from 0.3 to 2.9 percent among the six states GAO reviewed. The varying effects on enrollment by state could be attributable to several factors, including the share of eligible beneficiaries enrolled in Medicare savings programs prior to the outreach, each state's ability to handle increased call and application volume, and a state's income and asset limits. Four states GAO reviewed reported increases in the numbers of calls received or applications mailed or received following the SSA mailing and then decreases after the mailing period ended. Each of the states GAO reviewed reported that the state or other stakeholders conducted additional outreach during SSA's 2002 outreach. SSA generally agreed with GAO's findings. CMS stated that it did not have specific comments on the report.