Policy Round Up: Updated vaccine guidance; increasing enrollment in Medicare Savings Programs; Voting access

November 16, 2021
Vicki Gottlich, Director - Center for Policy and Evaluation

In this Policy Round Up, you’ll find:

  • Latest COVID-19 guidance 
  • Comments needed: CMS interim final rule on vaccine requirements 
  • From CMS: Two strategies for states to increase enrollment in Medicare Savings Programs 
  • Input Needed: Document on Addressing Voting Barriers for People with Disabilities

Updated CDC recommendations for COVID-19 vaccination

CDC now recommends that children 5 to 11 years old be vaccinated against COVID-19 with the Pfizer-BioNTech pediatric vaccine. You can find links to the latest CDC guidance and other information related to pediatric vaccines on our COVID-19 vaccine information page.

Vaccine requirements for employers

On November 4, CMS released an interim final rule (with comment period) requiring COVID-19 vaccination of staff who work in all Medicare and Medicaid-certified facilities. This includes, among others, hospitals, nursing homes, Intermediate Care Facilities for People with Intellectual Disabilities (ICF-IIDs), Psychiatric Residential Treatment Facilities (PRTFs), home health agencies, and Programs for All-Inclusive Care for the Elderly (PACE) programs. It does not include Medicaid-funded home and community-based settings. (The resources linked below include the complete list of covered providers.) 

That same day, the Department of Labor’s Occupational Safety and Health Administration (OSHA) also released its emergency temporary standard, which requires businesses with at least 100 employees companywide to ensure their employees get vaccinated against the coronavirus or wear a mask and test for COVID-19 on at least a weekly basis. (OSHA’s rule has been temporarily blocked by the 5th U.S. Circuit Court of Appeals in New Orleans after lawsuits challenging the rule were filed in several states.) 

You can learn more through the following: 

From CMS: Two strategies for states to increase enrollment in Medicare Savings Programs 

Medicare Savings Programs (MSPs) help pay for Medicare Part A and Medicare Part B premiums, deductibles, coinsurance, and copayments. Eligibility varies by program, but most people qualify based on income level. ACL’s State Health Insurance Assistance Program (SHIP) and State Medicaid Agencies can help people determine if they qualify. 

In a Nov. 1 informational bulletin, CMS encourages states to adopt two strategies to help more people enroll in these programs. In addition to informing the advocacy work of the aging and disability networks, the bulletin also includes information that can help our networks identify older adults and people with disabilities who likely would be eligible for the programs.

Here’s a quick overview of the strategies: 

1. Improve alignment of Medicare Part D Low Income Subsidy (LIS) and MSP programs
Most Medicare beneficiaries who receive full LIS (also known as “Extra Help”) should also qualify for Medicare Savings Programs – the programs generally have the same income requirements. MSP coverage begins on the same day that a person submits their LIS application. So, beneficiaries may be eligible for retroactive savings after enrolling in the MSP.

However, there are 1.25 million people enrolled in full LIS who are not enrolled in an MSP. In some states, as many as nearly 24 percent of people in LIS may qualify for additional support through an MSP but are not receiving it.
The Social Security Administration helps streamline MSP enrollment by sharing LIS data with all states. The Medicare Improvements for Patients and Providers Act of 2008 requires states to use that data to start MSP applications. However, current practices in many states do not fully comply. CMS’ informational bulletin emphasizes that states should not:

  • Send a blank MSP application or a letter instructing the applicant how to apply 
  • Request information from beneficiaries that is already contained in the LIS data

CMS also is encouraging states to further simplify the process for enrolling in an MSP by taking advantage of statutory authorities available to them that would better align LIS and MSP eligibility criteria. Currently, the two programs have the same resource eligibility levels, but there are statutory differences in how eligibility for the programs is calculated. States could eliminate some of these differences by adopting several Medicaid flexibilities. For example, states can choose to disregard certain income and assets that are counted for MSP but not LIS, such as in-kind support, cash value of life insurance, and burial exclusion. They also can increase the effective income level needed to qualify for MSPs. Finally, states can adopt the family size definition for LIS when determining eligibility for MSPs.

2. Increase enrollment in the Qualifying Individuals Program

The Qualifying Individuals Program covers Medicare Part B premiums for people who have limited income but do not qualify for Medicaid.  This program is fully funded by the federal government – no state funding is required to pay these premiums.  However, CMS estimates that over 3 million eligible people are not enrolled. 

To increase enrollment, CMS encourages states to:

  • Accept self-attestation for types of income that might be burdensome to document (such as the cash value of whole-life life insurance policies)
  • Partner with community-based organizations, including aging and disability resource centers, State Health Insurance Assistance Programs, area agencies on aging, and centers for independent living to reach those who may be eligible 

Input Needed: Document on Addressing Voting Barriers for People with Disabilities

Bottom line: The National Institute of Standards and Technology (NIST) is seeking comment on a draft document regarding recommendations for addressing barriers to voting for people with disabilities. Comments must be received by 5:00 pm Eastern time on Monday, November 22, 2021. 

Why this is important: The Constitution and laws of the United States protect the right to vote, yet people with disabilities continue to face barriers to voting and are denied legally required accommodations in exercising this fundamental right. Under Section 7 of the Executive Order on Promoting Access to Voting, NIST is directed to evaluate the steps needed to ensure that the online Federal Voter Registration Form is accessible to people with disabilities, analyze barriers to private and independent voting for people with disabilities, and make recommendations to remove these barriers. 


Last modified on 11/16/2021


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