Analyzing Rural Enrollment in Qualified Medicare Beneficiary Program Lags Behind Urban

The latest Report to Congress from the non-partisan Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) shows that the number of rural Qualified Medicare Beneficiaries (QMBs) who also receive full Medicaid benefits stayed relatively the same between 2010 and 2021, while the number living in urban areas increased.  These “QMB plus” enrollees receive assistance from Medicaid with their Medicare premiums and cost sharing plus full Medicaid benefits through eligibility pathways, such as Supplemental Security Income benefits and the aged, blind, and disabled pathway for individuals who are low income and age 65 or older or who have a qualifying disability.  This growing disparity between urban and rural enrollment may indicate that there are opportunities for future outreach to enroll more eligible rural enrollees in this assistance program.  This report also provides recommendations to Congress to increase transparency in Medicaid and CHIP financing, tools that states can use to optimize state Medicaid agency contracts, and improvements to demographic data collection in Medicaid.