Congress Addresses Low-Income Medicare Beneficiary Issues
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Congress Addresses Low-Income Medicare Beneficiary Issues

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December 17, 2013

Congressional Wrap-Up

See what else Congress passed and punted before leaving town for the holidays.

In its Medicare physician payment bill, the Senate Finance Committee did not make the Qualified Individual (QI) low-income program permanent as 112 national organizations requested, but it would extend the program for five years.

The budget bill Congress will pass this week also includes a three-month Medicare extenders package, including QI and funding for low-income outreach and enrollment activities. There will be additional opportunities to make QI permanent in January.

QI pays Part B premiums for beneficiaries with incomes between 120-135% of poverty, or about $13,700 to $15,550 per year.

What Happened

The Senate Finance and House Ways and Means Committees approved different versions of legislation to reform the Medicare physician payment system, sometimes referred to as the Sustainable Growth Rate (SGR).

Both bills would move the system from one that pays Medicare physicians primarily based on volume to one with a greater emphasis on quality, efficiency, and value. However, neither committee included provisions on how to pay for the package, which is likely to cost about $150 billion over 10 years. 

The Finance Committee considered other programs that needed to be extended, but the Ways and Means Committee will deal with these issues early next year.

Despite requests from a broad range of national groups and grassroots advocates, the Finance Committee did not make the QI program permanent, but it would extend it for five years. 

The Finance Committee bill also includes a  provision to permanently allocate $25 million per year for Medicare low-income outreach and enrollment activities.

NCOA was successful in getting 60 diverse national groups, including faith-based organizations and those representing seniors and people with disabilities, to sign a letter calling for a permanent QI fix. Families USA also circulated a letter on QI and other Medicaid provisions. Combined, 112 national organizations support making the QI program permanent.     

To avoid a major cut in physician payments and ensure that QI and other programs do not expire on Dec. 31, the House voted last week and the Senate will vote this week to include a three-month extension of various Medicare programs in its budget agreement.

The extension also includes $12.5 million to reach and enroll low-income Medicare beneficiaries into benefits as follows:

  • $3.75 million each for Area Agencies on Aging and State Health Insurance Assistance Programs
  • $2.5 million for Aging and Disability Resource Centers
  • $2.5 million to contract with NCOA's Center for Benefits Access

What’s Next

There are still advocacy opportunities to make the QI program permanent and protect beneficiaries against increasing out-of-pocket costs or benefit cuts to pay for the Medicare physician payment package.

The House and Senate Committees will continue working on their Medicare bills in January, with floor votes possible in February. 

Please watch your email for additional updates and alerts as things progress.

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