Medicaid: A Lifeline for Kidney Patients

Medicaid is vital to kidney patients

• Nearly half of all dialysis patients use Medicaid as a supplement to their Medicare coverage
• Prevents patients from having to choose between medical care and other basic needs. Protects people from medical debt due to ESRD.
• Allows people to focus on health, rather than worrying about how to pay for treatment or qualify financially for transplant
   

What is Medicaid?

• Joint federal-state health insurance program that provides coverage for millions of Americans with low income, disabilities, or high medical needs.
• Helps pay for doctor visits, hospitalizations, medications, and other essential health services.
• Eligibility is based on income and varies by state.
• If you have ESRD and limited financial resources, Medicaid can cover many of the healthcare costs that you might be unable to afford otherwise
  Benefits and rules can differ by state, and state Medicaid programs have different names. Check to find your state's Medicaid program and its eligibility rules. 

How Medicaid helps kidney patients

Fills critical gaps for people with ESRD. Nearly half of all dialysis patients rely on Medicaid coverage. Medicaid supports our community in important ways:

• "Dual coverage" with Medicare: Many ESRD patients are "dual eligible," meaning they have both Medicare and Medicaid.
  • Most patients w/ESRD qualify for Medicare, but Medicare covers only about 80% of medical costs and has no cap on out-of-pocket spending. Medicaid steps in to help.
  • Pays for expenses Medicare doesn't cover such as 20% coinsurance on dialysis treatments, deductibles, and Medicare premiums. Saves patients on Medicare from being burdened with medical bills they can't afford
• Coverage for those not on Medicare: Some dialysis patients do not qualify for Medicare due to not enough work credits. And everyone who is eligible for Medicare must go through a 90-day waiting period after starting dialysis before Medicare coverage kicks in. Medicaid can serve as primary insurance during these gaps. It ensures no one has to go without coverage.
• Services beyond dialysis that Medicare doesn't cover:
  • Medicaid varies by state but it can cover services like transportation to dialysis clinics, home health aides or nursing services, dialysis supplies, nutrition counseling.
• Transplant:
  • Transplant centers often require patients to have primary and secondary coverage. Medicaid as secondary coverage makes transplants possible. 

The Medicare Savings Program, QMB, SLMB, QI, and QDWI 

Overview 

The Medicare Savings Program (MSP) is a program that requires the state Medicaid program to help pay for Medicare Part A and Part B premiums, deductibles, copays, and co-insurance* for lower income Medicare beneficiaries. The programs are called Qualified Medicare Beneficiary (QMB) program, Specified Low-Income Medicare Beneficiary (SLMB) program, Qualifying Individual (QI) Program, and Qualified Disabled & Working Individual (QDWI) Program. They are administered by the states. 

QMB: The Qualified Medicare Beneficiary (QMB) program is for certain Medicare beneficiaries with, for 2025, monthly income limits of $1,325 for an individual and $1,783 for a married couple. The program will pay for Medicare Part A premiums (if that premium is not free), Medicare Part B premiums, and all copays and coinsurance. It is illegal for health care providers to bill QMB individuals for any Medicare cost-sharing, including deductibles, copayments, and coinsurance. 

SLMB: The Specified Low-Income Medicare Beneficiary (SLMB) program is for certain Medicare beneficiaries who have higher incomes than those in QMB. For 2025, monthly income limits for SLMB are $1,585 for an individual and $2,135 for a married couple. The program requires the state Medicaid program to pay for the Medicare Part B premium for Medicare beneficiaries enrolled in Medicare Part A and Medicare Part B. For 2025, the Medicare Part B premium is $185 and for 2026, it is $206.50. 

QI: The Qualifying Individual (QI) Program is for Medicare beneficiaries with slightly higher incomes than SLMB. For 2025, the monthly income limits for QI are $1,781 for an individual and $2,400 for a married couple. The QI program will pay the Medicare Part B premium; however, these benefits are not guaranteed as they are paid out on a first come, first served basis until funds run out. The program also assists with Medicare Part D drugs. For 2025, QI beneficiaries will pay no more than $12.15 for each prescription. 

QDWI: The Qualified Disabled & Working Individual (QDWI) Program is for disabled people who lost their Social Security disability benefits and premium-free Medicare Part A. The program pays for the Medicare Part A premium. 

Economic Resource Limits 

For QMB, SLMB, and QI, Medicare beneficiaries with economic resources including stocks, bonds, checking accounts, savings or retirement accounts exceeding a certain amount will not be eligible for these programs. Medicare beneficiaries with economic resources exceeding $9,660 for an individual and $14,470 for a married couple are not eligible for the QMB, SLMB, and QI programs. 

For QDWI, Medicare beneficiaries with economic resources exceeding $4,000 for an individual and $7,135 for a married couple are not eligible for assistance. 

Changes Under H.R. 1, the One Big Beautiful Bill 

Although MSP, QMB, SLMB, QI, and QDWI do not use the word, "Medicaid," in most of their letters to beneficiaries, it is the state run Medicaid program that administers these programs. Hence, the state will send letters to beneficiaries to certify income or to request other information. Depending on the state, Medicare beneficiaries who are in an MSP program may receive a letter from their state requesting income information to stay enrolled in the program. 

H.R. 1, The One Big Beautiful Bill, delayed implementation of a rule that would have streamlined the process of determining if Medicare beneficiaries were eligible for these programs from April 2026 to September 2034.  

In September 2023, CMS finalized the rule entitled "Streamlining Medicaid: Medicare Savings Program Eligibility Determination and Enrollment." The delayed rule required states to enroll qualifying Medicaid beneficiaries into the QMB, SLMB, or QI programs without needing an additional application. The rule also required states to use the Medicare Part D Low Income Subsidy (LIS) as an application for the MSP, which would have made it easier for low-income dialysis patients to stay enrolled in these programs. This rule's effective date was November 17, 2023, and required the states to fully implement it by April 1, 2026. H.R. 1 postponed the state's implementation date for 8 years. The states will need to implement the law by 2034. 

Medicaid policy issues for kidney patients

Learn about Medicaid policy issues at the state and federal levels that may affect the kidney ESRD community. Understanding these issues can help you stay informed and advocate for yourself and others.

Federal policy challenges: Protecting the Medicaid program

Congress decides how Medicaid is funded and what basic rules all states must follow. Right now, there are debates in Congress about the future of Medicaid. Some proposals could significantly change or reduce Medicaid's funding and scope, which is why patient voices are crucial. Key federal issues include:

Ensuring stable funding (no cuts or caps): Proposals to cut funding or impose caps are extremely concerning. [list here some of the proposed ideas generally and impact they would have on patients]. 

Opposing added barriers (like work requirements): Only about 20% of dialysis patients are able to work full time because of their illness and the demanding schedule of dialysis treatment and recovery. Healthcare access shouldn't depend on your ability to work when coping with a life-threatening, chronic illness.

We urge the federal government to keep Medicaid strong and accessible, and reject changes that would harm kidney patients.

In the states: Coverage differences and challenges

Each state runs its own Medicaid program within federal guidelines. Where you live determines whether you qualify for Medicaid and what benefits you can get. Key state issues include:

Medicaid expansion: 

Under ACA, states have the option to expand Medicaid to cover more low-income adults. Most states (41 plus DC) have done so, but a handful (about 9 states as of 2025) have not. In non-expansion states, some individuals with low income still can't get Medicaid unless they are extremely poor or qualify under strict disability criteria. 

Studies show that in states which expanded Medicaid, patients have better health outcomes. 

State decisions about Medicaid benefits:

Language about how states decide which health benefits to cover like transport to dialysis, access to home dialysis training etc.

Importance of advocacy in states to protect Medicaid funding to protect these services

Maintaining eligibility and enrollment: 

Language about states reevaluating Medicaid rolls (after COVID-19 emergency period) and importance that ESRD patients don't get mistakenly dropped during this process. 

Maybe a bullet with a practical suggestion on what to do if you're on Medicaid to ensure you aren't dropped — respond to renewal notices, keep contact info up to date

Take action: Tell lawmakers to protect Medicaid for kidney patients

By speaking out, you can help ensure that Medicaid remains strong for all who need it. 

• Send a message to Congress: Use this action alert to quickly email your Representatives and Senators. We've provided a drafted message about the importance of Medicaid for kidney patients, asking Congress to oppose any cuts or harmful changes to Medicaid and to support positive improvements. You can personalize it with your story for even more impact. Lawmakers want to hear from constituents like you.
• Why it matters: Language about how policymakers take notice when they hear from constituents; you can help your representative learn what Medicaid means to kidney patients; you have the power to influence policy.