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GAO-13-177R 1 (2012-12-12)

handle is hein.gao/gaobacgsz0001 and id is 1 raw text is: GAO Accountablty *Integrity * Reliability United States Government Accountability Office Washington, DC 20548 December 12, 2012 The Honorable Orrin G. Hatch Ranking Member Committee on Finance United States Senate The Honorable Joseph R. Pitts Chairman Subcommittee on Health Committee on Energy and Commerce House of Representatives Subject: Medicaid: Enrollment and Expenditures for Qualified Individual and Transitional Medical Assistance Programs Qualified Individual (Q) and Transitional Medical Assistance (TMA) are particular programs within Medicaid that are targeted to specific groups of low-income individuals.1 The Q1 program provides assistance to certain low-income Medicare beneficiaries by paying for their Medicare Part B premiums and is due to expire on December 31, 2012.2 The TMA program offers up to 1 year of additional Medicaid health insurance benefits for certain low-income families who would otherwise lose coverage. Under permanent provisions of the Social Security Act (SSA), Medicaid coverage continues for 4 months for families who would otherwise lose coverage due to an increase in earned income or hours of employment or increased child or 1Medicaid, a joint federal-state program that finances health insurance coverage for certain categories of low-income individuals, spent about $389 billion on coverage for eligible enrollees in fiscal year 2010. States administer Medicaid within broad federal guidelines that specify categories of low-income individuals that states must cover and categories that are optional. For example, in 1996, section 1931 of the Social Security Act (SSA) established a new mandatory Medicaid eligibility group of low-income families with children that are eligible to receive TMA coverage. See Pub. L. No. 104-193, § 114,110 Stat. 2105, 2177 (adding section 1931 to the SSA) (codified at42 U.S.C. § 1396u-1). 2Medicare is a federal health insurance program for individuals age 65 and over, individuals under the age of 65 with certain disabilities, and individuals with end-stage renal disease. Medicare has four parts, which cover different aspects of care for the population. In general, Medicare Part A covers hospital and inpatient care, Part B covers certain outpatient care, medical supplies, and preventive services, Part C is a managed care coverage option known as the Medicare Advantage program, and Part D provides an optional outpatient prescription drug benefit. The QI program was established by the Balanced Budget Act of 1997. See Pub. L. No. 105-33, § 4732, 111 Stat. 251, 520 (adding new sections 1902(a)(10)(E)(iv) and 1933 to the SSA) (codified at 42 U.S.C. §§ 1396a(a)(10)(E)(iv), 1396u-3). GAO-13-177R Medicaid for Certain Populations Page I

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