State Health Insurance Assistance Program (SHIP)

State Health Insurance Assistance Program (SHIP)

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Updated October 23, 2023
State Health Insurance Assistance Program (SHIP)
Background
on-one client contacts and an additional 2.6 million
The State Health Insurance Assistance Program (SHIP)
individuals through public events explaining the Medicare
provides funding to states for outreach, counseling, and
program and its benefits in the grant year beginning April 1,
information assistance to Medicare beneficiaries and their
2021, and ending March 31, 2022.
families and caregivers on Medicare and other health
Funding
insurance issues. The national program is authorized under
Section 4360 of the Omnibus Budget Reconciliation Act of
The majority of SHIP funding is provided through
1990, as amended (OBRA ’90; P.L. 101-508; 42 U.S.C.
discretionary budget authority in the annual Departments of
1395b-4).
Labor, Health and Human Services, and Education, and
Related Agencies (LHHS) Appropriations Act.
The Consolidated Appropriations Act, 2014 (P.L. 113-76)
Discretionary funding is also supplemented by mandatory
transferred SHIP administration from the Centers for
funding for outreach and assistance to low-income
Medicare & Medicaid Services (CMS) to the
Medicare beneficiaries (see Table 1).
Administration for Community Living (ACL). This
transfer, effective in 2016, reflected the existing formal and
Table 1. State Health Insurance Assistance Program
informal collaborations between the state SHIP projects and
(SHIP) Funding, by Type (FY2009 to FY2023)
the networks served by ACL.
Discretionary Mandatory
There are SHIP projects in all 50 states, as well as the
Year
Funding
Funding
District of Columbia and three U.S. territories (Guam,
Puerto Rico, and the U.S. Virgin Islands). Of the 54 SHIP
FY2009
$47,400,000
$7,500,000
grant programs, about two-thirds are administered by State
FY2010
$46,960,000
$15,000,000
Units on Aging established under the Older Americans Act.
FY2011
$52,000,000
a
The remaining one-third are located in their state insurance
commissioner offices. SHIP services are often delivered in
FY2012
$52,115,000
a
partnership with local Area Agencies on Aging and other
FY2013
$46,040,000
$7,115,000b
community-based organizations.
FY2014
$52,115,000
$7,500,000
Grant Activities
FY2015
$52,115,000
$7,500,000
SHIP grants provide funding for states to plan and operate
FY2016
$52,115,000
$13,000,000
various information, counseling, and assistance activities.
Medicare beneficiaries have received assistance through
FY2017
$47,115,000
$12,103,000c
one-on-one counseling in person, by telephone, on the
FY2018
$49,115,000
$13,000,000
Internet, or through email from paid and volunteer SHIP
FY2019
$49,115,000
$13,000,000
counselors. State SHIP projects also conduct public
outreach and education activities to inform beneficiaries
FY2020
$52,115,000
$13,000,000
about coverage and enrollment options.
FY2021
$52,115,000
$15,000,000
The SHIP grants support a community-based network of
FY2022
$53,115,000
$15,000,000
state and local programs that provide personalized
FY2023
$55,242,000
$15,000,000
assistance to Medicare beneficiaries and their families on
questions related to Medicare, supplemental insurance
Source: HHS, ACL and CMS budget justifications (FY2009 through
policies (Medigap), Medicare Advantage plans, Medicare
FY2023); P.L. 115-245, P.L. 110-275, as amended (see 42 U.S.C.
Savings Programs, Medicaid eligibility and coverage issues,
1395b-3 note; and personal communication with ACL.
long-term care insurance, and other health insurance issues.
Notes: Amounts are not adjusted for inflation.
a. The Patient Protection and Affordable Care Act (P.L. 111-148,
Since the passage of the Medicare Prescription Drug,
as amended) appropriated $15 mil ion for FY2010-FY2012.
Improvement, and Modernization Act of 2003 (P.L. 108-
173), a major focus of SHIP-funded programs has been to
b. $7.5 mil ion appropriated; amount reflects 5.1% reduction due
help beneficiaries obtain Medicare prescription drug
to mandatory spending sequester.
coverage, Medicare Part D, and enroll in the Medicare
c. $13 mil ion appropriated; amount reflects 6.9% reduction due to
prescription drug low-income subsidy program and in
mandatory spending sequester.
Medicare Savings Programs.
Discretionary Funding
According to ACL, over 12,500 SHIP team members, half
OBRA ’90 (P.L. 101-508) authorized the appropriation of
of whom were volunteers, in over 2,200 local organizations
$10 million in equal parts from the Medicare trust funds
connected with almost 1.8 million individuals through one-
(i.e., the Federal Hospital Insurance Trust Fund and the
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State Health Insurance Assistance Program (SHIP)
Federal Supplementary Medical Insurance Trust Fund) for
$75,000. Guam and the U.S. Virgin Islands each receive
each of FY1991 to FY1993. Congress and the President
$25,000.
subsequently extended SHIP authorizations of
Variable amount (remainder of first $10 million, if any):
appropriations to FY1996 under P.L. 103-432. While the
Each entity receives an amount based on a formula that
authorization of appropriations expired in FY1996,
considers the percentage of all Medicare beneficiaries
discretionary funding has continued to be provided through
nationwide who reside in the state (75%), the percentage of
the annual appropriations process. Discretionary budget
the state’s Medicare beneficiaries who reside in rural areas
authority for SHIPs is provided to ACL in the LHHS
(15%), and the percentage of the state’s Medicare
appropriations bill and funds discretionary grants to states
beneficiaries to the state’s total population (10%).
as well as ACL program support.
The Consolidated Appropriations Act, 2023 (P.L. 117-328),
ACL Discretionary Formula
provided just over $55 million in discretionary
The Discretionary Formula allocation applies to any
appropriations for SHIPs under ACL’s Aging and
available funding above the first $10 million. It includes a
Disability Services Programs budget authority for FY2023.
base funding amount and a formula for the remaining
This is just over $2 million (or 4%) more than the FY2022
funding.
funding level. In addition, some states supplement federal
Base funding: Each state, the District of Columbia, and
funding for SHIP programs with state funding.
Puerto Rico receives a fixed amount of $75,000. Guam and
Mandatory Funding
the U.S. Virgin Islands each receive $25,000.
SHIPs also receive mandatory funding for outreach and
Remaining funding: Each entity receives an amount based
assistance to low-income Medicare beneficiaries, which
on a formula that considers the (1) percentage of all
was first provided for FY2008 under the Medicare,
Medicare beneficiaries nationwide who reside in the state
Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-
(80% of remaining funds), (2) the number of beneficiaries
173). Beginning in FY2009, mandatory funding was
in the state below 150% of the Federal Poverty Level (10%
provided under the Medicare Improvements for Patients
of remaining funds), and (3) the percentage of the state’s
and Providers Act (MIPPA, P.L. 110-275; 42 U.S.C.
Medicare beneficiaries who reside in rural areas (10% of
1395b-3 note).
remaining funds).
This mandatory funding has been extended multiple times,
Mandatory Grants to States
most recently in the Consolidated Appropriations Act, 2021
SHIP grant amounts under MIPPA are provided to states
(P.L. 116-260), through FY2023. In addition to SHIPs,
based on a statutory funding formula (42 U.S.C. 1395b-3
mandatory funding for Medicare outreach and assistance to
note). The total mandatory funding amount to each state is
low-income beneficiaries under MIPPA is provided to Area
the sum of two separate allocations based on the following:
Agencies on Aging, Aging and Disability Resource Centers
and for benefits outreach and coordination to older
Allocation based on percentage of low-income
Americans. This provision requires the HHS Secretary to
beneficiaries: Two-thirds of the state’s total allocation is
transfer specified amounts to SHIPs from the Medicare trust
based on the number of individuals who meet the
funds. At present, mandatory SHIP funding for MIPPA
requirements for the low-income subsidy under the
activities is appropriated to CMS and transferred to ACL.
Medicare Part D prescription drug program but who have
not enrolled to receive a subsidy, relative to the total
Discretionary Grants to States
number of individuals who meet the requirements under the
SHIP discretionary grants are provided to states (including
subsidy program in the state, as estimated by the HHS
certain U.S. territories) based on formulas specified in
Secretary.
regulation and guidance. The total discretionary grant
Allocation based on percentage of rural beneficiaries:
amount to states is based on two types of funding
One-third of the state’s allocation is based on the number of
allocations: (1) Regulatory Formula, and (2) ACL
Medicare Part D eligible individuals residing in a rural area
Discretionary Formula. Funds are awarded for a five-year
relative to the total number of such individuals in the state,
project period. The most recent grant period began April 1,
as estimated by the HHS Secretary.
2020, and is to end March 31, 2025. Subject to available
funding, no state’s total funding is to increase or decrease
Additional Resources
by more than 5% from one budget year to the next.
The ACL-funded SHIP National Technical Assistance
Center (www.shiphelp.org) is a central source for program
Regulatory Formula
information. The center provides training, technical
The Regulatory Formula allocation includes a fixed amount
assistance, and other activities to support state projects and
and a variable amount that applies to the first $10 million
includes a directory of SHIP contacts in each state.
of available funding.
Kirsten J. Colello, Specialist in Health and Aging Policy
Fixed amount (first $10 million): Each state, the District
IF10623
of Columbia, and Puerto Rico receives a fixed amount of

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State Health Insurance Assistance Program (SHIP)

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