State Health Insurance Assistance Program

To provide information, counseling, and assistance relating to obtaining adequate and appropriate health insurance coverage to individuals eligible to receive benefits under the Medicare program.

To provide information, counseling, and assistance relating to obtaining adequate and appropriate health insurance coverage to individuals eligible to receive benefits under the Medicare program.

Grants or cooperative agreements may be made to States and U.S. Territories with approved State regulatory programs under section 1882 of the Social Security Act.

Individuals eligible for Medicare benefits, including Part D drug benefits, and older persons eligible for benefits and services provided under Medicare, their families, and caregivers.

A State shall submit a plan for a State-wide SHIP program. Such program shall - A) Establish or improve upon a health insurance information, counseling, and assistance program that provides counseling and assistance to eligible individuals in need of health insurance information, including: i) Information that may assist individuals in obtaining benefits and filing claims under titles XVIII and XIX of the Social Security Act; ii) Policy comparison information for Medicare supplemental policies (as described in section 1882(g)(1) of the Social Security Act) and information that may assist individuals in filing claims under Medicare supplemental policies; iii) Information regarding long-term care insurance; and iv) Information regarding other types of health insurance benefits that the Secretary determines to be appropriate; B) In conjunction with the health insurance information, counseling, and assistance program described in subparagraph (A), establish a system of referral to appropriate Federal or State departments or agencies for assistance with problems related to health insurance coverage (including legal problems), as determined by the Secretary; C) Provide for a sufficient number of staff positions (including volunteer positions) necessary to provide the services of the health insurance information, counseling, and assistance program; D) Provide assurances that staff members (including volunteer staff members) of the health insurance information, counseling, and assistance program have no conflict of interest in providing the counseling described in subparagraph (A); E) Provide for the collection and dissemination of timely and accurate health care information to staff members; F) Provide for training programs for staff members (including volunteer staff members); G) Provide for the coordination of the exchange of health insurance information between the staff of departments and agencies of the State government and the staff of the health insurance information, counseling, and assistance program; H) Make recommendations concerning consumer issues and complaints related to the provision of health care to agencies and departments of the State government and the Federal Government responsible for providing or regulating health insurance; I) Establish an outreach program to provide the health insurance information and counseling described in subparagraph (A) and the referrals described in subparagraph (B) to eligible individuals; and J) Demonstrate to the satisfaction of the Secretary, an ability to provide the counseling and assistance required under this section.

Grants/cooperative agreements are generally funded on a 12 month basis, with support beyond the first year contingent upon acceptable evidence of satisfactory progress, continuing program relevance, and availability of funds.

The review process for grants/cooperative agreements consists of initially screening applications for completeness and relevancy to ACL priority areas. If the application is not relevant to ACL priority areas, it will be returned to the applicant. If accepted as submitted it will be reviewed and evaluated. The review will be conducted by a panel of not less than three experts. ACL Project officer or designee will coordinate the panel's review , but will not vote. This individual or supervisor will also prepare the panel's recommendation to the ACL Administrator. The panel's recommendations will contain numerical ratings, rankings of applications, and a written assessment of each application. The recommendations will be based on published criteria as stated in the program announcement. The review process is also stated in the program announcement.

Application forms are submitted through a centralized depository and received by the awarding agency Administration for Community Living. Applicants generally apply under a program announcement indicating all the necessary application procedures to be followed.

If a grant/cooperative agreement application is recommended for approval for 2 or more years, the awarded may be requested to annually submit a formal request for continuation accompanied by progress report which will be evaluated prior to a recommendation of continuation.

No formal appeals procedures. If an application is disapproved, the reasons for the disapproval will be fully stated. In the case of solicited proposals, extensions may be allowed to prepare revisions which clarify various aspects of projects.