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Updated February 4, 2019
State Health Insurance Assistance Program (SHIP)
Background
organizations connected with individuals through more than
The State Health Insurance Assistance Program (SHIP)
102,000 public and media events and 3.3 million one-on-
provides funding to states for outreach, counseling, and
one client contacts.
information assistance to Medicare beneficiaries and their
Funding
families and caregivers on Medicare and other health
insurance issues. The national program is authorized under
The majority of SHIP funding is provided through
Section 4360 of the Omnibus Budget Reconciliation Act of
discretionary budget authority provided annually in the
1990 (OBRA ’90; P.L. 101-508; 42 U.S.C. 1395b-4).
Departments of Labor, Health and Human Services, and
Education, and Related Agencies (LHHS) Appropriations
The Consolidated Appropriations Act of 2014 (P.L. 113-76)
act. However, discretionary funding is also supplemented
transferred SHIP administration from the Centers for
by mandatory funding for outreach and assistance to low-
Medicare and Medicaid Services (CMS) to the
income Medicare beneficiaries (see Table 1).
Administration for Community Living (ACL). This transfer
reflected the existing formal and informal collaborations
Table 1. State Health Insurance Assistance Program
between the state SHIP projects and the networks that ACL
(SHIP) Funding, by Type (FY2009 to FY2019)
serves. An interim final rule, effective February 4, 2016,
Discretionary Mandatory
reflected the transfer from CMS to ACL (81 Federal
Year
Funding
Funding
Register 5917, February 4, 2016). The interim final rule
was adopted without change on June 3, 2016 (81 Federal
FY2009
$47,400,000
$7,500,000
Register 35643, June 3, 2016).
FY2010
$46,960,000
$15,000,000
There are SHIP projects in all 50 states, as well as the
FY2011
$52,000,000
a
District of Columbia, Guam, Puerto Rico, and the Virgin
FY2012
$52,115,000
a
Islands. Of the 54 SHIP grant programs, about two-thirds
FY2013
$46,040,000
$7,115,000b
are administered by State Units on Aging established under
the Older Americans Act. The remaining one-third are
FY2014
$52,115,000
$7,500,000
located in their state insurance commissioner offices.
FY2015
$52,115,000
$7,500,000
Grant Activities
FY2016
$52,115,000
$13,000,000
SHIP grants provide funding for states to plan and operate
FY2017
$47,115,000
$12,103,000c
various information, counseling, and assistance activities.
FY2018
$49,115,000
$13,000,000
Medicare beneficiaries receive assistance through one-on-
one counseling in person, by telephone, on the Internet, or
FY2019
$49,115,000
$13,000,000
through email from paid and volunteer SHIP counselors.
Source: HHS, ACL and CMS budget justifications (FY2009 through
State SHIP projects also conduct public outreach and
FY2017); H.Rept. 115-952, p. 588 (FY2018-FY2019); P.L. 115-245,
education activities to inform beneficiaries about coverage
P.L. 110-275, as amended (see 42 U.S.C. 1395b-3 note); and personal
and enrollment options.
communication with ACL.
The SHIP grants support a community-based network of
Notes: Amounts are not adjusted for inflation.
state and local programs that provide personalized
a. The Patient Protection and Affordable Care Act (P.L. 111-148,
assistance to Medicare beneficiaries and their families on
as amended) appropriated $15 mil ion for FY2010-FY2012.
questions related to Medicare, supplemental insurance
b. $7.5 mil ion appropriated; amount reflects 5.1% reduction due
policies (Medigap), Medicare Advantage plans, Medicare
to mandatory spending sequester.
Savings Programs, Medicaid eligibility and coverage issues,
c. $13 mil ion appropriated; amount reflects 6.9% reduction due to
long-term care insurance, and other health insurance issues.
mandatory spending sequester.
Since the passage of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (P.L. 108-
Discretionary Funding
173), a major focus of SHIP-funded programs has been to
OBRA ’90 (P.L. 101-508) authorized the appropriation of
help beneficiaries obtain Medicare prescription drug
$10 million in equal parts from the Medicare trust funds
coverage, Medicare Part D, and enroll in the Medicare
(i.e., the Federal Hospital Insurance Trust Fund and the
prescription drug low-income subsidy program and in
Federal Supplementary Medical Insurance Trust Fund) for
Medicare Savings Programs.
each of FY1991 to FY1993. Congress and the President
subsequently extended SHIP authorizations of
According to ACL, in 2016 over 14,000 SHIP counselors,
appropriations to FY1996 under P.L. 103-432. While the
mostly volunteers, in over 1,300 community-based
authorization of appropriations expired in FY1996,
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State Health Insurance Assistance Program (SHIP)
discretionary funding has continued to be provided through
Fixed amount (first $10 million): Each state, the District
the annual appropriations process. Discretionary budget
of Columbia, and Puerto Rico receives a fixed amount of
authority for SHIPs is provided to ACL in the LHHS
$75,000. Eligible U.S. territories (American Samoa, Guam,
appropriations bill and funds discretionary grants to states
and the U.S. Virgin Islands) each receive $25,000.
as well as ACL program support.
Variable amount (remainder of first $10 million, if any):
The Department of Defense and Labor, Health and Human
Each entity receives an amount based on a formula that
Services, and Education Appropriations Act, 2019 (P.L.
considers the percentage of all Medicare beneficiaries
115-245), provided $49 million in discretionary
nationwide who reside in the state (75%), the percentage of
appropriations for SHIPs under ACL’s Aging and
the state’s Medicare beneficiaries who reside in rural areas
Disability Services Programs budget authority for FY2019.
(15%), and the percentage of the state’s Medicare
This was the same as the FY2018 funding level. The
beneficiaries to the state’s total population (10%).
FY2019 President’s budget request would have eliminated
discretionary funding for SHIPs. While ACL acknowledged
ACL Discretionary Formula
that this would reduce one-on-one counseling through the
The Discretionary Formula allocation applies to any
program, the agency stated that “Medicare beneficiaries
available funding above the first $10 million. It includes a
will continue to have access to online tools such as Plan
base funding amount and a formula for the remaining
Finder and to phone assistance such as CMS’s 1-800-
funding.
MEDICARE helpline.” In addition, some states also
provide funding for SHIP programs.
Base funding: Each state, the District of Columbia, and
Puerto Rico receives a fixed amount of $75,000. Eligible
Mandatory Funding
U.S. territories (American Samoa, Guam, and the U.S.
Virgin Islands) each receive $25,000.
SHIPs also receive mandatory funding for outreach and
assistance to low-income Medicare beneficiaries, which
Remaining funding: Each entity receives an amount based
was first provided for FY2008 under the Medicare,
on a formula that considers the (1) percentage of all
Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-
Medicare beneficiaries nationwide who reside in the state
173). Beginning in FY2009, mandatory funding was
(80% of remaining funds), (2) the number of beneficiaries
provided under the Medicare Improvements for Patients
in the state below 150% of the Federal Poverty Level (10%
and Providers Act (MIPPA, P.L. 110-275; 42 U.S.C.
of remaining funds), and (3) the percentage of the state’s
1395b-3 note). This mandatory funding has been extended
Medicare beneficiaries who reside in rural areas (10% of
multiple times, most recently in the Bipartisan Budget Act
remaining funds).
of 2018 (P.L. 115-123) through FY2019. In addition to
SHIPs, mandatory funding for Medicare outreach and
Mandatory Grants to States
assistance to low-income beneficiaries under MIPPA is
SHIP grant amounts under MIPPA are provided to states
provided to Area Agencies on Aging, Aging Disability
based on a statutory funding formula. The total mandatory
Resource Centers and for benefits outreach and
funding amount to each state is the sum of two separate
coordination to older Americans. This provision requires
allocations based on the following:
the HHS Secretary to transfer specified amounts to SHIPs
from the Medicare trust funds. At present, mandatory SHIP
Allocation based on percentage of low-income
funding for MIPPA activities is appropriated to CMS and
beneficiaries: Two-thirds of the state’s total allocation is
transferred to ACL.
based on the number of individuals who meet the
requirements for the low-income subsidy under the
Discretionary Grants to States
Medicare Part D prescription drug program but who have
SHIP discretionary grants are provided to states (including
not enrolled to receive a subsidy, relative to the total
certain U.S. territories) based on formulas specified in
number of individuals who meet the requirements under the
regulation and guidance. The total discretionary grant
subsidy program in the state, as estimated by the HHS
amount to states is based on two types of funding
Secretary.
allocations: (1) Regulatory Formula, and (2) ACL
Allocation based on percentage of rural beneficiaries:
Discretionary Formula. Funds are awarded for a three-year
One-third of the state’s allocation is based on the number of
period. Subject to available funding, no state’s total funding
Medicare Part D eligible individuals residing in a rural area
is to increase or decrease by more than 5% from one budget
relative to the total number of such individuals in the state,
year to the next. The most recent grant announcement is for
as estimated by the HHS Secretary.
the period that begins April 1, 2017, and ends March 31,
2020. Although American Samoa is eligible for the
Additional Resources
program (as described below), according to ACL it has not
The SHIP National Technical Assistance Center
applied for the grant.
(www.shiptacenter.org) is a central source for program
Regulatory Formula
information. The center provides training, technical
assistance, and other activities to support state projects and
The Regulatory Formula allocation includes a fixed amount
includes a directory of SHIP contacts in each state.
and a variable amount that applies to the first $10 million
of available funding.
Kirsten J. Colello, Specialist in Health and Aging Policy
IF10623
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State Health Insurance Assistance Program (SHIP)
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https://crsreports.congress.gov | IF10623 · VERSION 7 · UPDATED