Key Takeaways

  • Transitioning from expansion Medicaid to Medicare can pose challenges, as older adults may lose eligibility for certain benefits.

  • States can play an active role in ensuring older adults leaving expansion Medicaid get screened for other money-saving programs.

  • Learn how some states are doing this well, and how to advocate for smoother processes in your state.

The Affordable Care Act (ACA) gives states the option to expand their Medicaid programs to extend Medicaid coverage to low-income adults aged 19-64 with incomes up to 138% of the federal poverty level (FPL), through what is referred to as the “Adult Group.”

Once Medicare-eligible, expansion Medicaid eligibility ends. An individual can transition—if their income and assets are low enough—to traditional Medicaid for the aged, blind, and disabled population (ABD Medicaid) or a Medicare Savings Program (MSP). Yet income and asset rules for Adult Group Medicaid are usually less stringent than for traditional Medicaid programs, so people newly eligible for Medicare may discover that they are not eligible for ABD Medicaid. This circumstance makes it especially important to ensure that any transitioning individual is screened for and enrolled in an MSP if they qualify.

In 2017, the Medicare Rights Center completed an extensive review of Adult Group Medicaid-to-Medicare transition processes in states that have expanded Medicaid. This included exploring MSP screening and enrollment processes in expansion and select non-expansion states. The resulting issue brief, Toward Seamless Coverage: Identifying Enrollment Gaps and Opportunities in Medicare Transitions for People with Expansion Medicaid, draws on months of interviews with targeted states to identify state-specific promising practices and challenges related to:

  1. Identification of Adult Group beneficiaries transitioning to Medicare
  2. Beneficiary communications
  3. Determinations and redeterminations for ABD Medicaid and MSP eligibility

This paper aims to highlight promising state-specific practices that other states might adopt, as well as hurdles that states will work through in their own ways, seeking the most seamless coverage possible for lower-income older adults and people with disabilities. 

Expansion Medicaid Guide for Advocates

To better assist state advocates nationally who seek to learn about state transition processes, troubleshoot problems their clients are facing, and/or seek improvements to current processes, Medicare Rights Center–with support from NCOA–created this expansion Medicaid transitions guide. The guide includes useful terminology, an overview of the main steps in transition processes, a review of the most common transition pathways, with state-specific examples, and a set of troubleshooting steps to consider when encountering problems.

Ensuring that Medicare beneficiaries receive the benefits they are eligible for is essential as the U.S. population ages and the Medicare and Medicaid landscapes continue to shift. Based on Medicare Rights’ findings from the research noted above, this guide serves as a road map that state advocates can use to help residents access Medicare and other insurance programs.

Webinar on Medicaid-Medicare Transitions

The Medicare Rights Center presented a webinar summarizing this research to the NCOA network. Join presenter Julie Carter, an attorney and a Federal Policy Associate in Medicare Rights Center’s DC office, as she talks about:

  • Findings from an extensive review of Adult Group Medicaid-to-Medicare transition processes in states that have expanded Medicaid.
  • Challenges that states encounter while trying to implement a seamless transition.
  • Promising practices in ABD Medicaid and MSP screening and enrollment processes in both expansion and select non-expansion states.