HHS’s Biggest Move in a Decade to Improve Care for Older Adults, People With Disabilities

WASHINGTON—The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), finalized a rule to streamline enrollment in the Medicare Savings Programs (MSPs), making coverage more affordable for an estimated 860,000 people. CMS estimates the improvements will save older adults and people with disabilities nearly 19 million hours in paperwork each year and reduce state administrative burden by more than 2 million hours annually. All told, this action, together with the progress made under President Joe Biden’s prescription drug law will help an estimated 1.2 million older adults and people with disabilities with limited income afford their Medicare coverage and health care costs.

The MSPs, run by state Medicaid programs, currently cover Medicare premiums and, in most cases, cost-sharing for more than 10 million older adults and people with disabilities who also have limited incomes. The final rule makes it easier for millions to enroll in, retain and afford health coverage and care through Medicare.

“Throughout my career, I have dedicated myself to ensuring that Americans have access to health insurance so that they can survive and thrive,” said HHS Secretary Xavier Becerra. “This rule brings us closer to that goal as we expand access and coverage for older Americans and people with disabilities.”          

“Building on President Biden’s executive orders to expand affordable, quality health coverage, CMS’s new rule will further protect and strengthen health care coverage for older adults and people with disabilities,” said CMS Administrator Chiquita Brooks-LaSure. “This final rule will help hundreds of thousands of people access health care while also freeing up already limited income for food, housing, and other life necessities.”

The MSPs provide vital links to coverage and care. However, only about half of eligible people are enrolled in the MSPs, in part due to cumbersome application and verification processes now simplified by this rule.

For example, all Medicare-eligible individuals who receive Supplemental Security Income (SSI) are financially eligible for MSPs, but many are not enrolled because of burdensome and duplicative paperwork. Under the new final rule, many SSI recipients will now be enrolled automatically into the most comprehensive form of MSP coverage: the Qualified Medicare Beneficiary eligibility group, which covers Medicare premiums and cost-sharing.

Under the rule, states will also make better use of data from the Medicare Part D Low Income Subsidy (LIS) or “Extra Help” program, which helps many older adults and people with disabilities pay for prescription drugs and prescription drug coverage when they live on a limited income. Concurrently, CMS and the Social Security Administration are preparing to implement provisions of Biden’s prescription drug law that expands eligibility for the full LIS benefit, allowing an estimated 300,000 people to have lower drug costs starting January 1, 2024. Taken together, the final rule and the drug law’s expansion of the LIS program make Medicare more affordable for seniors and people with disabilities.

Overall, these and other changes will improve access to health care and limit the need for people to apply separately for largely similar programs, like MSPs and LIS.

This marks the latest of ongoing updates from the Biden-Harris Administration to streamline eligibility and enrollment in Medicaid, the Children’s Health Insurance Program, and the Basic Health Program. On August 31, 2022, CMS released a notice of proposed rulemaking to put forward a host of related groundbreaking strategies. To consider and address all of the more than 7,000 comments on that proposed rule, the agency plans to issue two final rules: The first is being issued now; the second detailing remaining policies is anticipated in 2024.