Promises unfulfilled: Implementation of expanded coverage for the elderly poor

Objective. To examine implementation of the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs, enacte d in 1988. The article summarizes the origin of the QMB and SLMB programs, describes what we have learned about QMB and SLMB enrollment in state Medic aid programs and, despite some encouraging news on the federal front, ident ifies policy issues that remain in assuring access to health care for the l ow-income elderly. Source. Based in part on research that assessed state variations in Medicai d QMB and SLMB enrollment of low-income Medicare beneficiaries and identifi ed best practices among states in administration of the QMB and SLMB progra ms. Study Design. Telephone interviews were conducted with officials in ten sta tes to elicit qualitative information about how state Medicaid programs hav e implemented federal protections for low-income Medicare beneficiaries. Principal Findings. The QMB and SLMB programs fail to reach a sizable propo rtion of potentially eligible individuals in most states. Fragmentation of Medicare and Medicaid benefits, complex Medicaid eligibility and income ver ification processes, and rigid federal and state administrative and data sy stems, impede efforts to achieve promised protection for low-income elderly persons. Conclusions. For low-income Medicare beneficiaries, obtaining financial pro tection against their high out-of-pocket health care costs remains an impor tant issue. The complexities associated with aligning Medicare and Medicaid to deliver health benefits to low-income older persons makes improved coor dination across federal and state agencies uncertain.