The Fate of the QI Benefit up in the Air as Congress Weighs “Doc-Fix”

Today, both the Senate Finance Committee and the House Committee on Ways & Means considered legislation to permanently repeal and replace the Sustainable Growth Rate (SGR) formula. Without Congressional action, the SGR calls for sizable cuts to Medicare reimbursements to physicians and other providers. For the last decade, Congress has acted on an annual basis to avert these drastic cuts, commonly known as the “doc-fix.” The legislation considered today would gradually transition Medicare to a system where doctors are paid on the basis of the value of care provided, as opposed to the volume of services ordered. Medicare Rights Center supports transitioning to a reformed payment system that emphasizes value—essentially better quality care at a lower price. Yet, Medicare Rights remains deeply concerned about the future of critical Medicare benefits annually extended alongside the annual SGR patch. Critical among these is the Qualified Individual (QI) program. The QI benefit covers the cost of the Part B premium for Medicare beneficiaries with limited incomes, from about $14,000-$15,500 a year, and less than $7,080 in assets. Amounting to about $105 per month in 2013, this vital assistance helps vulnerable seniors and people with disabilities afford health care costs and other basic needs that they might otherwise go without. Legislation approved by the House Committee on Ways & Means earlier today does not yet address the QI program and other extender programs, while the Senate Finance Committee framework only extends the QI program through 2018. Earlier this week, 112 organizations, including Medicare Rights, urged members of Congress to ensure QI is made permanent alongside a permanent SGR fix. In addition to leaving concerns regarding critical extender programs unresolved, the House and Senate Committees have yet to address how the SGR repeal and replacement policy will be paid for. As these negotiations move ahead, Medicare Rights urges Congress not to shift added costs to people with Medicare.