1. Meeting the Challenge of Expanded Eligibility Determination Requirements for the Part D Subsidy Laura Summer Georgetown University Health Policy Institute October 8, 2004

2. Simple is better A complex process poses barriers to enrollment The simpler the enrollment process, the lower the administrative costs With less to explain, there is a greater likelihood of providing effective information, counseling, and assistance

3. Some different challenges Enrollment process differs for groups of beneficiaries A two-step process Many entities involved with the application and enrollment process [CMS, SSA, State Medicaid Programs, SPAPs, Managed Care Plans Prescription Drug Plans (unknown), Aging, Disability, and other Social Service Programs]

4. How to simplify enrollment for full duals Consider how autoenrollment will work Insure that full duals can be identified accurately Develop and modify information systems to accommodate the transition Consider the proposed timeframe for transition

5. How to simplify enrollment for MSPs Determine how to inform them of eligibility and the need to enroll in a plan Assist with enrollment Be prepared to respond to questions –Concerns about eligibility for other benefits, estate recovery –Confusion about the relationship between Part D and MSP benefits

6. How to reduce confusion regarding MSP and Part D subsidy benefits Secretary can opt to allow use of state MSP rules States can align MSP rules with subsidy SSA involvement in MSP eligibility determinations

7. How to simplify enrollment for others SPAP participants, Discount drug cardholders Other “unknown” low-income beneficiaries Use different approaches to reach the elderly, those with disabilities Insure that approaches are appropriate (culture, linguistics, literacy)

8. How to make the subsidy application process as simple as possible Simple applications Simple definitions for resources Minimal requirements for verification documents

9. How to keep people enrolled Evidence that financial circumstances don’t change substantially over time Use passive renewals Provide year-long continuous eligibility

10. Also for consideration Outcomes of current efforts to facilitate enrollment for discount drug cards Utility of the CMS information tools now and for the future Ongoing efforts to simplify enrollment for the Medicare Savings Programs