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MANAGED CARE May 1998. ©1998 Stezzi Communications

WASHINGTON INITIATIVES

Mixing and matching Medicare and Medicaid

• Color charts

Gaps in Medicare coverage can mean significant out-of-pocket expense for low-income elderly and disabled recipients. Many such Medicare recipients are eligible for Medicaid assistance for Part B premiums and services not covered by Medicare, such as prescription drug coverage. But a report by the Kaiser Commission on the Future of Medicaid suggests that bureaucracy and poor promotion keep few "dual eligibles" from claiming their full share of benefits. The commission says the emerging role for managed care in Medicare and Medicaid offers the promise of coordinated care for dual eligibles.

Medicaid benefits available to Medicare recipients:

• Full Medicaid benefits are available to Medicare recipients who are entitled to Supplemental Security Income or have incurred large health expenses.
• Qualified Medicare beneficiaries (QMBs) have incomes below 100 percent of poverty and limited assets. Medicaid pays Medicare's premiums and deductibles for this group, but only 63 percent of 367,000 QMBs received Medicaid benefits in 1996.
• Specified low-income Medicare beneficiaries (SLMBs) have incomes 100—120 percent of poverty and limited assets. Medicaid pays Medicare Part B premiums for this group, but only 10 percent of 195,000 SLMBs received Medicaid benefits in 1996.

The Balanced Budget Act of 1997 provides states with block grants to help Medicare recipients pay Part B premiums. Beneficiaries with incomes between 120 and 135 percent of poverty are entitled to full payment of Part B premiums, while those whose incomes are between 135 and 175 percent are eligible for coverage for a portion of benefits.

SOURCE: MEDICAID'S FINANCIAL PROTECTIONS FOR MEDICARE'S POOR AND NEAR-POOR, HENRY J. KAISER FAMILY FOUNDATION, MENLO PARK, CALIF., 1997