1 

State Health Insurance 

Assistance Program 

(SHIP)

Report to Congress

GY 2018 

Prepared by

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living

Office of Healthcare Information and Counseling
2 

Contents

Executive Summary....................................................................................................................................... 3

Introduction .................................................................................................................................................. 4

History........................................................................................................................................................... 4

Growing Population and Increasing Service Needs.................................................................................. 4

2018 Program Performance.......................................................................................................................... 5

SHIP Performance Data............................................................................................................................. 5

Challenges Frequently Reported by People with Medicare ..................................................................... 8

SHIP Innovations.....................................................................................................................................10

Administration Overview............................................................................................................................12

2018 Program Initiatives.........................................................................................................................12

Conclusion...................................................................................................................................................15

Appendix A: 2018 State Health Insurance Assistance Program Grant Awards ..........................................16

Appendix B: SHIP Performance Measures & Likert Ratings........................................................................17
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Executive Summary

The State Health Insurance Assistance Program (SHIP) provides Medicare beneficiaries with information, 

counseling, and enrollment assistance. Its mission is to empower, educate, and assist Medicare-eligible 

individuals, their families, and caregivers to make informed health insurance decisions that optimize 

access to care. SHIPs provide unique, personal, free, and in-depth assistance that is not replicated under 

any other Federal program.

The SHIP program was created in 1990 under Section 4360 of the Omnibus Reconciliation Act (OBRA) 

(Pub. L. 101-508) and is administered by the Administration for Community Living (ACL). In Grant Year

(GY) 2018, ACL received a discretionary appropriation for $49.1 million. ACL invested these dollars in 54

grants to states to provide local service to Medicare beneficiaries, staff to support and monitor grantees, 

and administrative support contracts and grants to provide technical assistance, support, and 

continuous improvement for the program.

During 2018: 

• SHIPs had nearly 2.7 million contacts with Medicare beneficiaries, their families, and 

caregivers, accounting for 1.57 million hours of one-to-one assistance. 

• On average one-on-one counseling sessions covered three complex Medicare topics and took 

35 minutes.

• SHIPs hosted 64,300 outreach events, including interactive presentations, participation in 

community and health fairs, and over 12,500 enrollment events. 

• During the enrollment events, SHIPs assisted roughly 185,000 Medicare beneficiaries, their 

families, and caregivers with plan comparisons. 

This report details SHIP program activities and their impact on beneficiaries during the 2018 grant year

(April 1, 2018 to March 31, 2019), including a brief history of SHIP, highlights from the 54 SHIP state 

grantees, challenges people with Medicare report to SHIP, and program innovations. Additionally, a brief 

description of administrative initiatives for the 2018 fiscal year (October 1, 2018 to September 30, 2019) 

is included. 
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Introduction

The State Health Insurance Assistance Program (SHIP) is a national program that offers one-on-one 

assistance, counseling, and education to Medicare beneficiaries, their families, and caregivers to help 

them make informed health benefits decisions. The U.S. Department of Health and Human Services’

Administration for Community Living (ACL) provides Federal grants to states to fund local SHIPs and 

establish community-based networks of counselors who assist in-person and by phone, make group 

presentations, and use a variety of media sources to educate people with Medicare. SHIPs provide 

unique, personal, free, and in-depth assistance that is not replicated under any other Federal

program.

The SHIP 2018 fiscal year (FY) actual appropriation was $49.1 million, with $44.9 million provided to 

states and territories for the SHIP State Base Grants and the remainder funds administrative initiatives

to support the work of the grantees. There are 54 SHIP grantees – one in each state, the District of 

Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. Two-thirds of grant recipients are State 

Units on Aging and the other one-third are State Departments of Insurance. 

History

The SHIP program was created under Section 4360 of the Omnibus Reconciliation Act (OBRA) of 1990 

(Pub. L. 101-508), which authorized the Secretary of the U.S. Department of Health and Human Services 

(HHS) to make grants to States to establish and maintain health insurance advisory service programs for 

Medicare beneficiaries. The grants fund SHIPs to provide direct, local assistance with Medicare 

(including the Original Medicare (Parts A and B) program, Medicare Advantage (Part C), and the 

Medicare Prescription Drug (Part D) program), Medicaid, and other health insurance options, including 

Medicare supplement insurance (also called Medigap), long-term care insurance, and managed care 

options. 

Growing Population and Increasing Service Needs

Over the last decade, the Medicare beneficiary population grew nearly 31%, from 45.4 million (2008) 

to 59.5 million (2018). Meanwhile, Federal funding for the SHIP program grew roughly 15%, from 

$42.6 million (2008) to $49.1 million (2018). The table below depicts annual Federal funding levels

since 2014, and steady growth in the Medicare population (which is expected to continue to grow). 

Medicare Population and SHIP Discretionary Appropriation Comparison, 2014-2018

2014 2015 2016 2017 2018

Total Federal Funding (millions)* $52.1 $52.1 $52.1 $47.1 $49.1

Funding to State Grantees (millions) $48 $48 $48 $43.5 $44.9

Funding Growth Rate Since 2014 0% 0% -10% -6%

Medicare Population (millions) 54.1 55.6 57.1 58.5 59.5

Medicare Population Annual Growth Rate 3% 3% 2% 1.7%

*Excludes Medicare Patients and Providers Act (MIPPA) funding designated for the SHIPs as that work is outside the scope of 

this report.
5 

A full list of SHIP grantees and the 2018 Grant Year funding amounts can be found in Appendix A.

2018 Program Performance

SHIPs provide Medicare beneficiaries unbiased information to empower them to make the best health 

care choices for themselves. This section highlights SHIP grantee performance from the 2018 grant year.

SHIP Performance Data

SHIPs serve as the main source for Medicare information and assistance in the community. They do so in 

two ways: 1) conducting outreach activities to inform the public about Medicare and other related 

health coverage options; and 2) providing individualized personal assistance to people with Medicare, 

their families, and caregivers (including enrollment assistance). 

SHIPs report a decrease in the number of beneficiaries assisted due to unstable funding and difficulty 

training staff on the new SHIP Tracking and Reporting System (STARS), which the network transitioned 

to in Grant Year 2018. Due to this transition, the performance data may be under representative of the 

work performed. More information on this transition can be found in the 2018 Program Initiatives 

section of this report. The data that follows is from the SHIP Tracking and Reporting System (STARS) for 

Grant Year 2018 (April 1, 2018 – March 31, 2019). 

Source: SHIP Performance Measures 1 (Client Contacts), 2 (Outreach Contacts), and 5 (Enrollment Contacts). See Appendix B 

for background on the SHIP Performance Measures.

46.0

48.0

50.0

52.0

54.0

56.0

58.0

60.0

2014 2015 2016 2017 2018

SHIP Federal Funding Compared to 

Medicare Population, 2014-2018

Total Federal

Funding

(millions)

Medicare

Population

(millions)

Outreach & Education

One-on-One Assistance

Enrollment Assistance

Outreach & Education One-on-One Assistance Enrollment Assistance

2018 4,238,927 2,694,135 2,054,426

2017 3,468,778 2,937,127 2,386,123

Beneficiary Contacts Assisted by SHIPs, GY 2017 & 2018
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SHIPs provide education and counseling to all Medicare beneficiaries, with a special focus on beneficiary 

groups considered “hard-to-reach.” These groups include beneficiaries who are low income, who reside 

in rural communities, and/or are non-native English speakers. Additionally, SHIPs target outreach and 

assistance to beneficiaries under age 65. 

In Grant Year 2018, 12,518 SHIP team members (nearly half of whom were volunteers) spent more than 

2.8 million hours helping Medicare beneficiaries understand and make educated choices about their 

healthcare coverage. Every SHIP is required to thoroughly screen, train, and certify each team member, 

including volunteers. Screening, training, and 

certification must happen before a SHIP counselor can 

work with any Medicare beneficiary. SHIPs are required 

to use ACL’s Volunteer Risk & Program Management 

Policies1

 to support their program management. Each 

SHIP determines how they will create training to meet 

these standards. The SHIP Technical Assistance Center 

has an Online Counselor Certification Tool which many 

of the states use for their training and certification.

Outreach & Education Activities

SHIPs conduct outreach activities throughout their local communities to educate the public about

Medicare and help people make informed healthcare decisions. In the 2018 grant year, SHIPs educated 

almost 3.6 million people at more than 64,300 events including in-person presentations, health or senior 

fairs, and enrollment events. Over 12,500 of these events were Enrollment Events which focused on 

providing in-person, one-on-one assistance to help people compare Medicare plans and complete 

enrollment applications.

1 ACL’s Volunteer Risk & Program Management Policies can be found at https://acl.gov/programs/seniormedicare-patrol/volunteer-risk-and-program-management-vrpm-policies) 

Beneficiaries under 65

Beneficiaries who Speak English as a Secondary

Language

Beneficiaries in Rural Communities

Beneficiaries with Limited Incomes

Beneficiaries under 65

Beneficiaries who Speak

English as a Secondary

Language

Beneficiaries in Rural

Communities

Beneficiaries with Limited

Incomes

2018 330,737 250,970 708,665 936,627

2017 446,693 333,195 634,168 1,077,692

Medicare Beneficiary Contacts who are "Hard-to-Reach" 

Assisted by SHIPs in GY 2017 & 2018

Source: SHIP Performance Measures 3 (Under 65 Contacts) and 4 (“Hard-to-Reach” Contacts as compared to Summary Data in 

STARS). See Appendix B for background on the SHIP Performance Measures.

Over 12,500 SHIP team members

(nearly half of whom were volunteers) 

spent more than 2.8 million hours

helping Medicare beneficiaries
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Presentations

SHIPs conducted approximately 36,000

interactive presentations that reached over 

1.65 million people. These presentations are 

tailored to the audience and highlight 

important dates and timely details about 

Medicare, including the basics of Medicare 

enrollment, coordination of benefits, as well as 

coverage options and details. SHIPs seek free and low-cost venues for these events, which are

often held in libraries, community rooms, senior centers, or church event spaces.

Health and Senior Fairs

SHIPs participated in over 15,700 fairs to raise awareness of their services for people with 

Medicare, their families, and caregivers. In addition to reaching people with Medicare, SHIPs

often use these opportunities to meet new local partner organizations that can help expand the 

reach of the SHIP services. 

Enrollment Events

SHIPs hosted over 12,500 enrollment events, reaching over 185,000 people with Medicare, their 

families, or caregivers. At an enrollment event, a SHIP counselor meets one-on-one with a 

beneficiary to enter their prescription drugs into the Centers for Medicare & Medicaid Services 

(CMS) Medicare Plan Finder, compare the available plan choices, and discuss the financial 

implications and coverage options. If a beneficiary would like to change plans, the SHIP 

counselor can complete an application on the beneficiary’s behalf through the Medicare Plan 

Finder. However, if the beneficiary wants more time to consider the decision, then they can

contact the SHIP counselor for enrollment assistance later or contact the insurance plan directly 

to enroll.

One-on-One Beneficiary Assistance

In 2018, SHIPs had over 2.7 million one-on-one contacts with Medicare beneficiaries, their families, and 

caregivers, providing in-depth information about Medicare benefits and other related healthcare 

questions or issues. These contacts often involve multiple subjects and require extensive counseling and 

assessment to properly address questions and issues.

The average time spent on one-on-one counseling

continues to increase annually, reflecting the continuous 

need for and complexities of SHIP counseling. It was 28 

minutes in 2014, 30 minutes in 2016, and 35 minutes in 

2018.

Beneficiaries contact SHIP with unique needs including but 

not limited to the following:

• Managing benefits when working beyond the age 

of Medicare eligibility; 

• Coordinating Medicare benefits with employer, 

workers compensation, military, or retiree 

coverage; 

SHIPs educated almost 3.6 million 

people at more than 64,300 events 

28 29 30 31

35

0

5

10

15

20

25

30

35

40

Average Minutes Per SHIP 

Contact, 2014-2018

Minutes
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• Completing applications for Medicare coverage or programs to help pay for Medicare costs; 

• Assisting with claims denials and appeals; and

• Shopping for long-term care insurance. 

On average one-on-one counseling sessions covered three complex Medicare topics. The chart below 

shows the frequency of topics discussed.

Challenges Frequently Reported by People with Medicare

SHIPs often counsel Medicare beneficiaries who report challenges with Medicare-related processes and 

policies. This section describes some of the challenges reported this Grant Year. In addition, per the 

authorizing statute, the SHIPs provided ACL with their recommendations for the challenges identified. 

Each of these issues and the associated recommendations are detailed briefly in the section below.

Medicaid and Medicare Coordination 

According to CMS, in 2018 there were approximately 12.2 million people enrolled in Medicare and 

Medicaid (also known as dually eligible beneficiaries).2 Beneficiaries who are dual eligible must 

coordinate their Medicare and Medicaid benefits which can be confusing. Additionally, Medicaid is 

administered on the state level and varies significantly across the country. The SHIPs reported the 

following systemic concerns from beneficiaries related to Medicaid. These are on-going concerns that 

the SHIPs have reported in prior years. 

Medicaid to Medicare Transitions

The Affordable Care Act gave states the opportunity to expand Medicaid to the adult population 

aged 19 through 64 and a majority have done so. Expanded Medicaid eligibility guidelines do not 

align with the guidelines for traditional Medicaid or the Medicare Savings Programs. As a result, 

SHIPs report the need for additional information to support beneficiaries who are turning 65 

and, therefore, transitioning from expanded Medicaid for the adult group to Medicare and may

be faced with higher health care costs than they had in the past. Each state varies in how they 

process beneficiaries who are transitioning between these programs.

2 https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/MedicareMedicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf 

Original Medicare

Medigap

Medicare Advantage

Medicare Part D

Part D LIS/Extra Help

Other Prescription Assistance

Medicaid

Other Insurance

Other Topics

0% 5% 10% 15% 20%

Frequency of Topic Discussed
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SHIPs recommend ongoing education for consumers and health insurance counselors to help 

beneficiaries understand the impact of this transition and what actions they need to take.

Medicaid Managed Care

Medicaid managed care is designed to manage cost and utilization for the state Medicaid 

programs. The state Medicaid agencies contract with managed care organizations to provide 

services. The SHIPs have noted that it can be difficult for beneficiaries to navigate the options 

available to them. Many SHIPs work closely with the Medicaid agency and managed care 

organizations to ensure beneficiaries have the information they need to make an informed 

decision about their health care. However, more support is needed from the network to 

properly assist beneficiaries with these options.

 

SHIPs recommend in depth national discussion and education about managed care programs, 

and how SHIPs can better help dually eligible beneficiaries.

Formalized Partnership with State Medicaid Agencies

SHIPs assist beneficiaries with understanding their Medicaid coverage, as well as their Medicare 

coverage. They work closely with the State Medicaid agencies in this effort; however, the nature 

of these partnerships varies across states. For example, each state determines who may have 

access to their system for eligibility and benefit verification. If the SHIP is not able to access the 

state system for benefit verification, it can make it difficult for the SHIP to help beneficiaries 

who are unsure of their current Medicaid coverage. Additionally, in some instances, State

Medicaid employees are not well versed in Medicare coordination or the SHIP program, which

leaves the beneficiary struggling to navigate these systems with limited support. 

SHIPs recommend national efforts to develop and maintain state level relationships with 

Medicaid agencies. This could include:

1. Educating team members at the State agencies on both programs (SHIP and Medicaid)

to fully support beneficiaries. 

2. A dedicated line for the SHIPs to use to connect with the Medicaid office to assist with 

eligibility and benefit verification and application processing. 

3. Granting appropriate access to Medicaid systems so that SHIP team members can verify 

beneficiary benefit information. 

Partnering with the Social Security Administration

The Social Security Administration (SSA) plays an important role by enrolling beneficiaries in Original 

Medicare (Parts A & B) and administering the Low-Income Subsidy for Medicare Part D/Extra Help. A 

stronger local partnership between the SHIPs and SSA offices would allow both SHIPs and SSA to better 

serve beneficiaries who are looking for Medicare information from SSA. Due to resource concerns, often 

SHIP team members are unable to reach SSA to troubleshoot beneficiary concerns. Additionally, SSA 

representatives are not appropriately trained on all aspects of Medicare or the SHIP program as a 

resource. 
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SHIPs recommend national efforts to develop and maintain local relationships with SSA offices. This 

could include:

1. Educating SSA team members about SHIP as a resource and partner to troubleshoot 

beneficiary questions and issues to more fully support beneficiaries. 

2. A dedicated line for the SHIPs to use to connect with SSA to assist with individual beneficiary 

questions and issues. 

Annual Medicare Plan Review

Since Medicare health and drug plan options change every year, it’s important for Medicare 

beneficiaries to reevaluate their Medicare coverage and plan choices annually during the Medicare 

Open Enrollment Period (October 15 – December 7). Beneficiaries often report challenges with the plan 

review process – related to both understanding changes to their current plan and comparing the other 

options available in their areas. 

Due to the challenges many beneficiaries experience with the annual plan review process, SHIPs spend 

the majority of the Medicare Open Enrollment Period helping people compare Medicare health and 

drug plans. SHIPs help beneficiaries make these comparisons by using the Medicare Plan Finder tool on 

Medicare’s website. However, comparing plans and using the Medicare Plan Finder can be a confusing 

and overwhelming process, particularly for those with low health insurance literacy, limited technology 

skills, limited English proficiency, or who reside in rural areas with poor internet access. Often 

beneficiaries express relief at finding their local SHIP for the clarity the volunteers and staff provide to 

the process.

The SHIP network recommends helping beneficiaries better understand their options by:

1. Promoting SHIP services nationally, allowing beneficiaries to have unbiased assistance 

comparing options.

2. Enhancing and updating Medicare Plan Finder so that beneficiaries are more easily able to 

compare plans online on their own.

3. Simplifying Annual Notices of Change, which list the changes in plan coverage, service area and 

costs that will go in to effect the following plan year and to include SHIPs as a resource in the 

plan materials. 

SHIP Innovations

SHIPs consistently seek efficiencies and reported these examples of innovative outreach strategies and 

team member training.

Education and Outreach 

SHIPs continue to look for new ways to find, educate, and enroll beneficiaries. The following are a few 

innovative examples from the network this year.

Hawaii’s Targeted Mail & Digital Campaigns

The Hawaii SHIP conducted an outreach campaign that included online and direct mail 

components. 

• Direct Mail Campaign - The postcard content, design, layout, and printing were 

developed to align with the digital media campaign set to launch around the same time.
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The postcard included the Help Line phone number, SHIP website, and dates of the 

Medicare Open Enrollment Period. Approximately 28,000 postcards were mailed in 

October to promote Hawaii SHIP services to beneficiaries who may not have email, 

access to a computer, or if they resided in a rural community with no Internet or Wi-Fi 

capabilities and were unable to see the ads or PSAs from the digital media campaign. An 

increase in calls and volunteer inquiries resulted from this wave of direct mailers.

• Digital Media Campaign - The digital campaign began in October 2018 and included 

multiple platforms and ad formats (including bonus free airtime). As of March 2019, the 

campaign has reached more than 2.65 million users and generated nearly 10,000 visits 

from interested users to the website. Each visit is purposeful, as they were generated by 

the ads and videos delivered in this campaign. The total overall Click Through Rate was 

0.42%, which is much higher than the industry average of 0.15%. The best performing 

strategy has been the Targeted Email, which generated more than 50% of the total visits 

to the website but accounted for less than 20% of all ads delivered. The analytics were 

provided by Raycom/KHNL Hawaii News Now.

Pennsylvania’s “Making SEN$E of your Medicare Part D Plan” Campaign

Pennsylvania SHIP developed a campaign targeting pharmacies entitled “Making SEN$E of your 

Medicare Part D Plan.” Local programs provided this handout to pharmacies and encouraged 

them to ask consumers two questions regarding their Medicare Part D coverage when they pick 

up their prescriptions: “Are you in the right prescription drug plan for you?” and “Do you need 

help paying for your prescription drugs?” Additionally, pharmacy staff placed the handout in the 

bag with the prescription and encouraged consumers to call the APPRISE program to learn about 

plan options.

Staff Training and Resources

SHIPs spend hours developing and training team members on the complexity of Medicare. Highlighted 

below are a few examples of innovations on this topic from Grant Year 2018.

Rhode Island’s Resource Chart

Rhode Island’s SHIP developed a Resource Chart with all income and resource guidelines for 

common benefits for low-income Medicare Beneficiaries. The chart included Extra Help,

Medicare Savings Programs, Medicaid, Supplemental Nutrition Assistance Program, Low-Income 

Heating and Energy Assistance Program, State Pharmaceutical Assistance Program, and Home 

Community Care Program. This Resource Chart was distributed to all SHIP Counselors to help 

determine if Medicare beneficiaries were eligible for any of these programs when conducting 

counseling appointments. This chart has helped to assist in reaching and targeting more lowincome Medicare beneficiaries in Rhode Island. 

Hawaii’s New Approach to Annual Statewide Re-Certification Training

Every January, Hawaii SHIP conducts a recertification training for volunteers, staff, partners, and 

SHIP trainers and/or data leads from each Area Agency on Aging. The training is conducted in a 

“Jeopardy” style format to make training fun, encourage networking among participants, and 

foster lesson retention. The three “games” feature 70 questions from the SHIP Technical 

Assistance Center’s Online Counselor Certification Tool that covers a wide range of Medicarerelated topics. A Final Jeopardy question is posed at the conclusion of training. Attendees are 

divided into teams—seated at round tables—to discuss possible answers from the multiple-
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choice questions. The event is held at the Kapiolani Community College—within the University 

of Hawaii system—to support the School of Culinary Arts. Culinary students gain experience 

preparing meal options for older adults that are tasty, visually appealing, and healthful. At the 

January 2019 training, SHIP recertified 48 counselors.

Administration Overview

The SHIP discretionary appropriation was $49.1 million in 2018, with $44.9 provided to 54 states and 

territories for the SHIP State Base Grants. The remainder was used to fund the following existing 

commitments, administrative costs, and the SHIP Technical Assistance Center used to support the 

SHIP network (more details on each is provided on the pages following): 

• SHIP Technical Assistance Center: A single cooperative agreement awarded to the North East 

Iowa Area Agency on Aging to provide technical assistance, training, and resources to the SHIP 

grantees to support the national network. This grant is in Budget Year 2 of 3.

• SHIP/Senior Medicare Patrol (SMP) Joint Conference Logistics: Synergy Enterprises Inc. was 

contracted in FY 2016 to provide SMP/SHIP grantee training conference logistics for four 

years. The second year was awarded in FY 2018. 

• SHIP/SMP Beneficiary Survey: The vendor, CG Strategies, provides oversight and management 

of a national survey used with Medicare beneficiaries served by SHIP and SMP programs to 

determine satisfaction and accuracy of the services provided. In 2018 this contract is in its 

second year.

• SHIP Tracking and Reporting System (STARS): Booz Allen Hamilton was contracted in FY 2016 

to develop the new data system to support the SHIP and Medicare Improvement for Patients 

and Providers Act (MIPPA) programs. This contract is in its second year.

• SHIP National Performance Reporting (NPR) System: Technical Frontiers, Inc. provides the 

oversight and analysis of the SHIP data system, which expired November 2018.

• Administrative and Program Support Costs: salaries and benefits; overhead/rent; travel, 

training, and conferences; grant systems; and IT hosting. 

2018 Program Initiatives

The SHIP Program is administered by ACL’s Office of Healthcare Information and Counseling (OHIC), 

which also oversees the Senior Medicare Patrol (SMP) and Medicare Improvements for Patients and 

Providers Act (MIPPA) programs. The SMP program provides outreach and education to Medicare 

beneficiaries to prevent, detect, and report Medicare fraud, errors, and abuse. The MIPPA program

provides grants to states and tribes to help older adults, individuals with disabilities, and their caregivers 

apply for special assistance through Medicare. Since many of the SHIP programs are co-located with 

SMP and MIPPA, often ACL Program Initiatives span all three programs. 

This grant year, ACL continued with initiatives to support the work grantees are doing. This includes 

communications and stakeholder engagement; technical assistance to grantees; and program 

evaluation. 
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Communications and Stakeholder Engagement

The SHIPs provide detailed and in-depth one-on-one assistance to Medicare beneficiaries in local 

communities across the country. The successful continuation of these activities requires a strong 

partnership with the Centers for Medicare & Medicaid Services (CMS) to provide technical assistance, 

support, and communication to the SHIPs on Medicare, Medicare changes, and beneficiary issues and 

questions. ACL participates in a number of CMS, and other Federal partner workgroups to ensure SHIPs 

receive timely Medicare and other relevant healthcare related updates. These workgroups also provide 

an opportunity for ACL to share SHIP and Medicare beneficiary experiences and successes, as well as 

challenges that are brought to the SHIPs, which may help inform Federal partner decisions.

Since the transfer of the SHIP from CMS in 2014, ACL has worked closely with CMS to continue and 

strengthen this partnership. During Medicare’s Open Enrollment Period in the Fall of 2018, ACL 

conducted a SHIP site visit for the Principal Deputy Administrators for CMS and ACL. The event included 

an in-depth Medicare 101 education session for 50 beneficiaries, one-on-one counseling sessions, and a 

round table with Medicare beneficiaries.

Technical Assistance to SHIP Grantees

ACL provides technical assistance to SHIP grantees through direct support from ACL staff and the award 

of grants and contracts that provide additional resources for grantees.

Support from ACL Staff

SHIP programmatic dollars fund ACL Project Officers to work closely with SHIP grantees to help 

them understand ACL’s policies and priorities, as well as how to properly oversee and manage 

their federal grants. Project Officers communicate with SHIP grantees regularly via email, 

webinars, and monthly conference calls to discuss SHIP questions and concerns, talk through 

any challenges, and identify promising practices that could be shared with the broader SHIP 

grantee network. ACL staff consult with SHIPs to develop solutions to emerging issues, as well as

review and provide feedback on programmatic progress reports. 

In addition to collaboration and monitoring, ACL staff manage several projects aimed at 

enhancing availability of SHIP services, including the SHIP Technical Assistance Center, SHIP data 

system, SHIP customer satisfaction survey, and SHIP national training meeting (all described 

below).

SHIP Technical Assistance Center (SHIP TA Center)

SHIP programmatic dollars fund the SHIP TA Center, which serves as a central resource for 

disseminating knowledge and best practices to SHIP grantees. The SHIP TA Center also provides 

ongoing support and information for SHIPs on issues and trends in Medicare, Medicaid, and 

volunteer management; develops new products and tools for the national SHIP network, 

including fact sheets and training manuals; and provides technical assistance to SHIP grantees 

through webinars, one-on-one assistance, and written instructions. The SHIP TA Center draws 

upon wide-ranging resources to respond to a rapidly changing programmatic environment and 

the issues associated with the national network that provides services and supports to older 

adults and people with disabilities in their homes and communities, Medicare, and the broader 

health insurance industry affecting Medicare beneficiaries.
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SHIP Data System

SHIP programmatic dollars fund the national reporting system, which was in transition in Grant 

Year 2018. In November, the SHIP National Performance Reporting (SHIP NPR) system was 

discontinued and all data was transferred to the new system - the SHIP Tracking and Reporting 

System (STARS). STARS provides more flexibility in reporting and data analysis, allowing ACL and 

the grantees to determine whether SHIPs are meeting the goals set forth by the agency and in 

the authorizing legislation. STARS also provides a connection with the Senior Medicare Patrol’s 

(SMP) data system, so the systems can share data. This increases efficiencies at the local level, 

since the same grantees and counselors complete much of the work. The rollout of STARS began 

in Spring 2018 and concluded in November 2018, when all 54 SHIPs began solely using STARS for 

reporting.

ACL staff provided technical assistance to the SHIP state grantees throughout the roll out. As 

with any data system transition, it took some time to get all 12,500 team members trained on 

the system and proficient in data entry. As a result, the Grant Year 2018 performance data is 

unlikely to fully reflect all SHIP efforts for the year. 

SHIP Customer Satisfaction Survey

SHIP programmatic dollars fund the administration of a SHIP Customer Satisfaction Survey. The 

goals of the survey are to measure satisfaction with SHIP Medicare counseling services, to assess 

how customers value the services and information they receive, to identify opportunities for 

continuous improvement, and to comply with regulatory requirements regarding data 

collection. Implementation of the survey began in FY 2017 and runs through FY 2020. 

Approximately one-third of the states will be surveyed during each year of implementation, with 

all covered by the project at the end of the 3-year cycle. The final report will provide an 

overview of the national results with state specific findings.

While the study is still under way, the years 1 and 2 preliminary results showed that 87% of 

respondents were satisfied with the counseling services they received. The chart below displays 

additional preliminary findings about customer satisfaction with SHIP counseling:

Question Text Average 

Score

Percent who “Agreed” 

or “Strongly Agreed”

Q4

I was able to find and contact 

SHIP in a timely fashion. 4.27 89%

Q6 The information provided to 

me was accurate.

4.27 87%

Q7 SHIP provided me with useful 

information. 4.30 88%

Q9 Overall, I was satisfied with 

my interaction with SHIP. 4.32 87%

Q10 I would contact SHIP again for 

assistance.

4.38 90%

Q11

I would recommend SHIP’s 

service to others. 4.38 89%
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SHIP National Training Meeting

ACL hosts a national training for SHIPs and SMPs annually. The purpose of the conference is to 

assist, support, and inform the program directors and their support staff nationwide. The 

meeting offers an opportunity to review core values and practices that define the programs, yet 

also hone new skills to strengthen the programs’ outreach efforts and the involvement of 

volunteers. This meeting also allows states to network and share information related to best 

practices with SHIP and SMP grantees in other states. In addition to grantees from other states, 

attendees are provided an opportunity to meet ACL staff, national partners like CMS and the 

National Council on Aging, and the SHIP TA Center staff.

During this reporting period the conference was held in Chicago August 20 – 23, 2018. Over 300 

people attended this conference. Presenters included staff from ACL, CMS, HHS-OIG, other 

national partners, and SHIP and SMP staff. Major topics included grants management, outreach, 

volunteer training, data reporting, reaching specific populations, and Volunteer Risk and 

Program Management policies.

Conclusion

SHIPs provide unique services to Medicare beneficiaries to help them make the best choice for their 

health care coverage. The 54 SHIP grantees serve as the main source for Medicare information and 

assistance in the community. They provide individualized personal assistance to people with Medicare, 

their families, and caregivers; and conduct outreach activities to inform the public about Medicare and 

other related health coverage options. Because of this service, beneficiaries often report relief after 

counseling sessions with the SHIP counselors. As the population of the United States grows older, SHIP 

services will continue to be a vital resource to help older Americans navigate the complexities of 

Medicare.
16

Appendix A: 2018 State Health Insurance 

Assistance Program Grant Awards 

State Award Amount State Award Amount

AL $ 824,998 NE $ 401,891

AK $ 221,067 NV $ 397,943

AZ $ 817,906 NH $ 275,952

AR $ 583,404 NJ $ 1,011,472

CA $ 4,206,131 NM $ 417,406

CO $ 585,725 NY $ 2,282,101

CT $ 525,457 NC $ 1,433,248

DE $ 195,604 ND $ 242,516

DC $ 148,645 OH $ 1,697,497

FL $ 2,688,994 OK $ 588,793

GA $ 1,114,731 OR $ 562,143

HI $ 241,739 PA $ 1,910,334

ID $ 374,143 RI $ 260,330

IL $ 1,474,572 SC $ 740,815

IN $ 844,985 SD $ 302,849

IA $ 665,994 TN $ 1,040,962

KS $ 506,805 TX $ 2,543,370

KY $ 817,182 UT $ 342,597

LA $ 641,695 VT $ 232,952

ME $ 420,207 VA $ 972,552

MD $ 715,864 WA $ 856,547

MA $ 912,230 WV $ 454,254

MI $ 1,404,956 WI $ 880,950

MN $ 899,320 WY $ 280,646

MS $ 576,269 GU $ 46,345

MO $ 890,454 PR $ 800,316

MT $ 538,516 VI $ 46,345

Project Period April 1, 2018 – March 31, 2019

Total Awards: $44,860,719
17

Appendix B: SHIP Performance Measures & Likert Ratings

SHIPs are evaluated on the following Performance Measures (PM): 

Performance Measure 1: Client Contacts - Percentage of total one-on-one client contacts (inperson, by phone, by e-mail, postal mail, or fax) per Medicare beneficiaries in the State.

This performance measure covers every one-on-one interaction SHIPs have with beneficiaries or 

on behalf of a beneficiary. It includes in-person counseling sessions (in the office or at the 

beneficiary's home); telephone conversations of all durations (including on-line call formats such 

as Skype); and email, postal mail and fax correspondence. It does not count unsuccessful 

attempts to reach beneficiaries (such as leaving messages); individuals reached through public 

events (unless the presenter has substantial individual interaction with a beneficiary after the 

event); contacts when the only purpose is to schedule a meeting; or mass emails.

Performance Measure 2: Outreach Contacts - Percentage of persons reached through

presentations, booths/exhibits at health/senior fairs, and enrollment events per Medicare 

beneficiaries in the State.

This performance measure is the number of people reached through presentations (including 

webinars and tele-conferences), booths/exhibits at Health/Senior Fairs or Special Events, and 

Enrollment Events. The event must include the provision of Medicare or SHIP information to the 

public. In order to count outreach contacts SHIPs must have the ability to monitor attendance 

and provide an opportunity for participants to ask questions and provide clarification at the time 

of the presentation.

Performance Measure 3: Contacts with Medicare Beneficiaries under 65 - Percentage of 

contacts with Medicare beneficiaries under the age of 65 per Medicare beneficiaries under 65 

in the State.

This performance measure includes the number of one-on-one contacts with Medicare 

beneficiaries who are under the age of 65. The beneficiary must be receiving or applying for 

Medicare and Social Security benefits due to a disability or; receiving Medicare because of the 

diagnosis of End-Stage Renal Disease. This does not include soon-to-be new to Medicare 

beneficiaries (i.e. those entering Medicare at age 65).

Performance Measure 4: Hard-to-Reach Contacts - Percentage of low-income, rural, and nonnative English contacts per total "hard-to-reach" Medicare beneficiaries in the State.

This performance measure is based on the number of contacts made with any of the designated 

hard-to-reach populations divided by the total number of beneficiaries in that population. The 

designated hard-to-reach populations include:

o Low-income beneficiaries - all contacts with beneficiaries whose income is below 150% 

Federal Poverty Level;

o Rural beneficiaries - all contacts with beneficiaries that live in areas with a population 

fewer than 50,000 as designated by the Office of Management and Budget (OMB); and

o Non-native English-speaking beneficiaries - all contacts with beneficiaries where English 

is not the beneficiaries first language.
18

Performance Measure 5: Enrollment Contacts - Percentage of unduplicated enrollment 

contacts (i.e., contacts with one or more qualifying enrollment topics) discussed per total 

Medicare beneficiaries in the State

This performance measure is the total unduplicated enrollment contacts as reported on the 

SHIP client contact form. It includes eighteen possible enrollment topics, such as assistance with 

enrollment in Medicare Part D plans, Medicare Advantage, the Low-Income Subsidy and 

Medicare Savings Programs.

Below are the national performance measure results from April 1, 2018 – March 31, 2019:

PM 1: Client Contacts – 2,694,135 Beneficiary Contacts (4.53% of eligible population)

PM2: Public Media Outreach Contacts – 4,238,927 Beneficiary Contacts (7.09% of eligible 

population)

PM 3: Medicare Beneficiaries Under 65 Contacts – 330,737 Beneficiary Contacts (3.81% of 

eligible population)

PM 4: Hard-to-Reach Contacts – 1,896,262 Beneficiary Contacts (4.89% of eligible population)

PM 5: Enrollment Contacts – 2,054,426 Beneficiary Contacts (3.45% of eligible population)

Additionally, ACL creates a Likert Rating for the grantees to provide them with an understanding of how 

they compare with their peers. Each grantee receives a Likert rating for each PM based on last grant 

year’s performance and a target Likert rating for each PM to work towards in this year’s grant year.

These ratings are shared with the SHIP network, which allows them to identify which states they can 

approach when they are looking for ideas for improvement.

The scale for each PM breaks down as follows:

Top 10% (5 States) Excellent

Next 20% (11 States) Good

Middle 40% (22 States) Average

Next 20% (11 States) Fair

Bottom 10% (5 States) Low

The ratings for this grant year follow.
19

National SHIP Performance Measure 1 Ratings for April 1, 2018 – March 31, 2019 Grant Year

Excellent:

Penetration Rate of 10.20% & Above

Guam

Iowa

Louisiana

Minnesota

Ohio

Good:

Penetration Rate of 5.91% to 10.19%

Alabama

Alaska

Nebraska

Pennsylvania

Puerto Rico

Rhode Island

South Dakota

Tennessee

Washington

Wisconsin

Wyoming

Average:

Penetration Rate of 3.19% to 5.90%

Connecticut

Idaho

Illinois

Indiana

Kansas

Kentucky

Maine

Maryland

Massachusetts

Michigan

Montana

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Utah

Vermont

Virgin Islands

West Virginia

Fair:

Penetration Rate of 2.21% to 3.18%

Arizona

Arkansas

California

Colorado

Delaware

Mississippi

Missouri

Oklahoma

Oregon

South Carolina

Virginia

Low:

Penetration Rate of 2.20% & Below

District of Columbia

Florida

Georgia

Hawaii

Texas

Performance Measure 1 – Total Client Contacts:

Percentage of total client contacts (in-person office, in-person home, telephone [all durations], and contacts by e-mail, postal, or fax) per Medicare beneficiaries in the State.
20

National SHIP Performance Measure 2 Ratings for April 1, 2018 – March 31, 2019 Grant Year

Excellent: 

Penetration Rate of 14.33% & Above

Montana

North Carolina

Pennsylvania

Puerto Rico

Rhode Island

Good:

Penetration Rate of 7.12% to 14.32%

Alabama

Alaska

California

Indiana

Nebraska

Ohio

Oklahoma

Oregon

Tennessee

Utah

Washington

Average:

Penetration Rate of 3.01% to 7.11%

Arkansas

Colorado

Connecticut

Guam

Hawaii

Idaho

Illinois

Iowa

Kansas

Kentucky

Louisiana

Maryland

Michigan

Minnesota

Missouri

Nevada

New Hampshire

New Jersey

New York

Texas

West Virginia

Wisconsin

Fair:

Penetration Rate of 1.70% to 3.00%

District of Columbia

Georgia

Maine

Massachusetts

Mississippi

New Mexico

South Carolina

South Dakota

Vermont

Virgin Islands

Virginia

Low:

Penetration Rate of 1.69% & Below

Arizona

Delaware

Florida

North Dakota

Wyoming

SHIP Performance Measure 2 – Outreach Contacts: 

Percentage of persons reached through presentations, booths/exhibits at health/senior fairs, and enrollment events per Medicare beneficiaries in the State.
21

National SHIP Performance Measure 3 Ratings for April 1, 2018 – March 31, 2019 Grant Year

Excellent:

Penetration Rate of 7.71% & Above

Iowa

Montana

Ohio

Rhode Island

South Dakota

Good:

Penetration Rate of 4.84% to 7.70%

Alabama

Alaska

Connecticut

Guam

Idaho

Indiana

New Mexico

Tennessee

Utah

Vermont

Wisconsin

Average:

Penetration Rate of 2.80% to 4.83%

California

Colorado

Delaware

Illinois

Kansas

Kentucky

Louisiana

Maine

Maryland

Michigan

Missouri

Nebraska

Nevada

New Hampshire

New York

Oregon

Pennsylvania

Puerto Rico

Virgin Islands

Washington

West Virginia

Wyoming

Fair:

Penetration Rate of 1.59% to 2.79%

Arizona

Arkansas

District of Columbia

Florida

Massachusetts

Minnesota

New Jersey

North Carolina

North Dakota

Oklahoma

Virginia

Low:

Penetration Rate of 1.58% & Below

Georgia

Hawaii

Mississippi

South Carolina

Texas

Performance Measure 3 – Medicare Beneficiaries Under 65: Percentage of contacts with Medicare beneficiaries under the age of 65 per Medicare beneficiaries under 65 in 

the State.
22

National SHIP Performance Measure 4 Ratings for April 1, 2018 – March 31, 2019 Grant Year

Excellent:

Penetration Rate of 10.45% & Above

Iowa

Louisiana

Minnesota

Ohio

South Dakota

Good:

Penetration Rate of 6.73% to 10.44%

Alabama

Kentucky

Nebraska

New Hampshire

Pennsylvania

Puerto Rico

Rhode Island

Tennessee

Utah

Washington

Wisconsin

Average:

Penetration Rate of 3.57% to 6.72%

Alaska

Colorado

Connecticut

District of Columbia

Guam

Idaho

Illinois

Indiana

Kansas

Maine

Michigan

Missouri

Montana

Nevada

New Mexico

New York

North Carolina

North Dakota

Vermont

Virgin Islands

West Virginia

Wyoming

Fair:

Penetration Rate of 2.25% to 3.56%

Arizona

Arkansas

Delaware

Maryland

Massachusetts

Mississippi

New Jersey

Oklahoma

Oregon

South Carolina

Virginia

Low:

Penetration Rate of 2.24% & Below

California

Florida

Georgia

Hawaii

Texas

Performance Measure 4 – Hard-to-Reach Contacts: Percentage of low-income, rural, and non-native English contacts per total “hard-to-reach” Medicare beneficiaries in the 

State. 
23

National SHIP Performance Measure 5 Ratings for April 1, 2018 – March 31, 2019 Grant Year

Excellent:

Penetration Rate of 6.99% & Above

Iowa

Nebraska

Ohio

South Dakota

Tennessee

Good:

Penetration Rate of 4.98% to 6.98%

Alabama

Alaska

Guam

Kansas

Massachusetts

Minnesota

Pennsylvania

Rhode Island

Washington

Wisconsin

Wyoming

Average:

Penetration Rate of 2.55% to 4.97%

Arkansas

Connecticut

Delaware

Idaho

Illinois

Indiana

Kentucky

Louisiana

Maine

Maryland

Michigan

Montana

Nevada

New Hampshire

New Mexico

New York

North Carolina

North Dakota

Utah

Vermont

Virgin Islands

West Virginia

Fair:

Penetration Rate of 1.69% to 2.54%

Arizona

California

Colorado

Mississippi

Missouri

New Jersey

Oklahoma

Oregon

Puerto Rico

South Carolina

Virginia

Low:

Penetration Rate of 1.68% & Below

District of Columbia

Florida

Georgia

Hawaii

Texas

Performance Measure 5 – Enrollment Contacts: Percentage of unduplicated enrollment contacts (i.e., contacts with one or more qualifying enrollment topics) discussed per 

Medicare beneficiaries in the State.