Streamlining Enrollment into Medicare Savings Programs and the Low-Income Subsidy Program: Lessons Learned
5 min read
Streamlining enrollment into Medicare Savings Programs (MSPs) and the Low-Income Subsidy (LIS) program could:
- Allow states to reduce administrative burdens associated with processing applications and conducting eligibility determinations
- Connect more low-income older adults to health care and prescription drug benefits
These key takeaways from case studies in Arizona, New York, Oregon, and Washington can guide other states’ approaches.
Background and purpose
Medicare Savings Programs (MSPs) and the Low-Income Subsidy (LIS) can help low-income older adults save $8,400 annually in out-of-pocket costs by paying for Medicare premiums, cost-sharing, and prescription drug coverage.1 However, despite similarities in eligibility criteria, millions of low-income older adults are not enrolled in both programs.2
Some states have taken actions to improve enrollment—such as using LIS application data from the Social Security Administration (SSA) (Leads data) to facilitate MSP enrollment, removing asset limits for MSPs, or aligning LIS and MSP eligibility criteria.
Streamlining MSP enrollment using these strategies could allow states to reduce administrative and resource burdens associated with processing applications and conducting eligibility determinations, while connecting low-income older adults to benefits that help them pay for their health care and prescription drugs.
Aligned with our commitment to disseminating cost-effective strategies for benefits outreach and enrollment for older adults, NCOA, in partnership with L&M Policy Research, sought to investigate states’ actions and approaches for streamlining enrollment into MSPs and LIS. The team developed case studies with four states—Arizona, New York, Oregon, and Washington—representing different stages of streamlining implementation and a range of geographic and policy contexts. The goal of these case studies was to& showcase each state’s experience with streamlining MSP and LIS enrollment and describe milestones achieved, challenges experienced, and lessons learned.
This resource highlights lessons learned and key strategies from the case studies that can guide states as they consider how to streamline their efforts.
| Federal law requires SSA to send states Leads data for the purpose of initiating MSP applications, but many states still do not use the data to facilitate MSP enrollment. For states that use the data, there is variation in how they use it for MSP enrollment (e.g., sending out blank MSP applications vs. automatically enrolling identified individuals into MSPs). Using application information from public benefits programs with overlapping eligibility criteria could help reduce barriers to enrollment for older adults and expedite the review and approval process of applications for states. |
In focus: Use of Leads data for MSP applications
Lessons learned from the case studies reveal strategies that could help facilitate and automate the use of Leads data:
- Strategy: Cross-reference other data systems to fill in gaps or resolve conflicting information& to facilitate the use of Leads data and automate MSP eligibility determinations. Data systems could include other public benefit program application data (via an integrated data system or data exchanges/agreements) or external data sources, such as state employment and income data.
- Rationale: Cross-referencing other data systems can help states automate eligibility determinations by removing the need to send out blank applications or requests for information to the individual, making the process more efficient for both states and consumers.
See: Arizona
- Strategy: If the eligibility system cannot cross-reference other administrative datasets, request only the information that is missing/needed to complete an MSP application. For example, the Leads data could be used to send pre-populated applications to the consumer, or eligibility workers could call consumers to request only the missing information.
- Rationale: Requesting only the information that is missing from the Leads data—rather than asking the consumer to fill out an entire blank application—minimizes burden on both state staff and the consumer.
See: Oregon, Arizona
- Strategy: Develop internal procedures and resources to support the needs of eligibility workers using the Leads data. For example, develop a guide to assist workers in making MSP eligibility determinations for consumers identified in the data.
- Rationale: More comprehensive guidance about MSP and LIS eligibility criteria and the Leads data can help eligibility workers become more familiar with the programs and the data file, which can streamline both eligibility determination and enrollment processes.
See: Oregon
| Variations in eligibility criteria across programs result in substantial state burden in conducting cross-program eligibility determinations and increase barriers to older adults applying for multiple programs. For MSP and LIS, financial eligibility criteria differ not only in dollar amount but also definitions. For example, forms of income and assets such as interest and dividends, non-liquid resources, and certain burial funds may be included in the financial eligibility definitions for MSP but not for LIS. Aligning eligibility requirements could help reduce barriers for states by more easily enabling the use of Leads data while also easing the burden on eligibility workers and consumers to distinguish definitions between programs. |
In Focus: Aligning MSP and LIS Eligibility Requirements
Lessons learned from the case studies reveal strategies that could help align MSP and LIS eligibility requirements:
- Strategy: Eliminate asset tests in MSP eligibility criteria.
- Rationale: Removing asset limits and verification processes helps converge MSP and LIS eligibility criteria, since they differ most significantly for assets. From a consumer perspective, eliminating limits reduces barriers to providing documentation needed for the state to verify asset information. From the state perspective, verifying asset information requires substantial administrative burden. Different asset definitions between programs also pose a significant challenge to states using Leads data to assess MSP eligibility; by eliminating these limits, states can streamline eligibility determinations by using Leads data while also reducing the resources required for asset verification.
See: Washington, Arizona, Oregon, New York
- Strategy: Increase or align MSP income thresholds, asset limits, and criteria definitions.
- Rationale: Given that financial eligibility criteria are more stringent for MSP than LIS, aligning income thresholds, asset limits, and definitions would result in more LIS enrollees being eligible for MSP. This could allow eligibility workers to more readily use Leads data without the added burden of requiring older adults to submit additional information.
See: New York, Washington
Resources to share
Sources
1. Medicare Rights Center. Medicare Savings Programs: A Lifeline for Millions. Aug. 7, 2025. Found on the internet at https://www.medicarerights.org/policy-documents/medicare-savings-programs-a-lifeline-for-millions
2. NCOA. Nine Million Older Adults Are Not Getting Benefits They Are Eligible For. Aug. 13, 2024. Found on the internet at https://www.ncoa.org/article/nine-million-older-adults-are-not-getting-benefits-they-are-eligible-for/
Photo copyright Jessica Schweitzer for NCOA use only
This publication was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $14,707,650.00 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS or the U.S. Government.
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