Medicare Modernization Act & Work
Incentives
by Lolly Lijewski
According to The Health
and Disability Advocates (HDA), a coalition of disability advocates
from Chicago, the new benefits that come through the newly-enacted
Medicare Modernization Act (MMA) for people with disabilities
may conflict with policy changes in work incentives enacted over
the past several years to empower people with disabilities to work
while still maintaining their health care benefits.
The two agencies that have
responsibility for implementing these new regulations are the Social
Security Administration (SSA), and the Centers for Medicare and Medicaid
Services (CMS). These two agencies should be working hand-in-hand
to make a smooth transition for consumers from the current system
to the new one, and for the most part they are succeeding. There
are, however, some exceptions which are important for beneficiaries
to be aware of, and to call to the attention of SSA and CMS staff
should they encounter them.
A major area of concern for HDA with the MMA is consistency between
the new MMA benefits, and existing benefits like SSI. CMS has given
advocates the impression that if an SSI beneficiary is deemed eligible,
they are eligible for successive years following the eligibility
determination, however, the regulations seem to indicate that SSI
beneficiaries have the possibility of being reviewed in successive
years. This is a mixed message.
It would be more advantageous
for beneficiaries if monthly reviews were an option. For example,
if the eligible beneficiary’s
income changes and they become unemployed in March, their eligibility
status would not be reviewed until the following January at which
time they could become eligible for additional benefits. But during
those intervening months between the time they became unemployed
and the redetermination, the SSI beneficiary would be without any
additional assistance in paying for their prescription drugs even
though their income decreased substantially.
The new MMA benefits
are supposed to follow the SSI rules including the student earned
income exclusion, but the regulations do not take this exclusion
into account. So, for example, students with disabilities who might
take a paid internship would have their income from the internship
counted against their annual income. This would reduce the amount
of “Extra Help” the student could receive.
HDA is also concerned
that Medicare Part D, doesn’t recognize
the Social Security trial work period for people on SSDI. The policy
solution to this issue would be to have Medicare Part D disregard
earned income during the trial work period in case the eligible beneficiary
becomes unemployed during the trial work period, they would still
need assistance with paying for their prescription drugs and could
maintain that coverage without experiencing a gap in their coverage
or having to go through another eligibility determination.
According to the HDA,
another potential barrier is for people with Developmental Disabilities.
If they are an SSDI beneficiary and have taken a job where they
are earning $1,000 a month but only producing $700 of work a month,
they are permitted under SSDI regulations to maintain their SSDI
check, even though they exceed the SGA level for SSDI. But under
the MMA, they would not be entitled to any additional “extra
help,” or low income subsidy. SSDI takes into account the $300
gap, but Medicare Part D does not.
Finally, business expenses
for self-employed beneficiaries are not recognized under Medicare
Part D. Income related work expenses and blind income related work
expenses are figured on a percentage. The percentages are 16.3 for
non-blind and 25 percent for blind income related work expenses.
An individual who has greater expenses will receive less help from
the new benefit set than individuals whose expenses are lower than
these percentages. This is a disincentive to work for an individual
who is self-employed or wants to become self-employed. For self-employed
beneficiaries, whose income changes on a monthly basis, monthly reviews
would be more beneficial than yearly reviews.
Implementation of a new law
is always a critical time for advocates and beneficiaries to be diligent
in observing where gaps in the regulations that govern the implementation
of the new law occur, and to call those gaps to the attention of
the implementing agencies. It is to the advantage of beneficiaries
of Social Security and Medicare to attend as many informational sessions
about these new programs as possible and to ask as many questions
as they can to clarify how these new programs will impact them. It
is imperative that these potential challenges do not prevent anyone
who believes they might be eligible for these new benefits from applying
for them.
This article is meant to help inform consumers so that
they can be better able to empower themselves to seek benefits they
are entitled to. An informed consumer is an empowered consumer.
There is also help available
to consumers by calling the Linkage Line at 1-800-333-2433, or Social
Security at 1-800-772-1213. For information on Medicare Part D
from CMS call 1-800-633-4227. Beneficiaries can also access information
online at www.ssa.gov, or
www.cms.hhs.gov. Health And
Disability Advocates can be reached at 312-223-9600.
