Toward Seamless Coverage: Transitions to Medicare from Expansion Medicaid
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The Affordable Care Act (ACA) gives states the option to expand their Medicaid programs, and 32 states including the District of Columbia have decided to do so. This expansion has extended 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.”

Toward Seamless Coverage issue brief cover

Download this issue brief highlighting best practices in expansion Medicaid to Medicare transitions.

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.

NCOA asked the the Medicare Rights Center to complete 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.

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NEW! 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–with support from the National Council on Aging (NCOA)–has 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 2016, this guide serves as a road map that state advocates can use to help residents access Medicare and other insurance programs.