State Health Insurance 

Assistance Program 

(SHIP)

Report to Congress

Grant Year 2016

Prepared by

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living

Office of Healthcare Information and Counseling
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Contents

Executive Summary .................................................................................................................................2

Introduction ............................................................................................................................................2

History ....................................................................................................................................................3

2016 Program Overview..........................................................................................................................4

Activities and Outcomes......................................................................................................................4

Frequently Reported Challenges with Medicare...................................................................................5

SHIP Innovations..................................................................................................................................9

Administration Overview....................................................................................................................... 10

2016 Program Initiatives.................................................................................................................... 10

Technical Assistance to SHIP Grantees............................................................................................... 11

Looking Ahead................................................................................................................................... 13

Appendix A – FY 2016 State Grant Funding Amounts............................................................................. 14
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Executive Summary

The mission of the State Health Insurance Assistance Program (SHIP) is to empower, educate, and assist 

Medicare-eligible individuals, their families, and caregivers through objective outreach, counseling, and 

training, to make informed health insurance decisions that optimize access to care and benefits. 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 FY 2016, ACL 

received a discretionary appropriation in the amount of $52.1 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 2016:

 SHIPs provided 1.6 million hours of one-to-one assistance to more than 3.2 million Medicare 

beneficiaries, their families, and caregivers. 

 The average one-to-one assistance session length was 30 minutes. 

 SHIPs hosted 57,000 outreach events including interactive presentations, participation in 

community and health fairs, and nearly 13,500 enrollment events. 

 During the enrollment events, SHIPs assisted more than 187,000 Medicare beneficiaries, their 

families, and caregivers with plan comparisons. Approximately 65 percent of attendees at 

these events chose to enroll in a Medicare health or drug plan with the assistance of a SHIP 

counselor.

This report details SHIP program activities during the 2016 grant year (April 1, 2016 to March 31, 2017) 

including a brief history of SHIP, highlights from the 54 SHIP state grantees, challenges people with 

Medicare report to SHIP, and program innovations. Also included is a brief description of current and 

future administrative initiatives such as the implementation of revised performance measures designed 

to better illustrate SHIP effectiveness, as well as, the development of a new SHIP data system with the 

goal of further improving grantee’s performance measurement abilities. 

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 Administration for Community Living (ACL) provides 

federal grants to states to fund local SHIPs and establish community-based networks of counselors who 

provide assistance 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. 

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 
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Departments of Insurance. Nationally, SHIP has a network of more than 3,300 local programs and nearly 

15,000 highly trained counselors, 57 percent of whom are volunteers. During the 2016 grant year, SHIP 

counselors provided over 7 million hours of counseling, outreach, and service to help people with 

Medicare, their families, and caregivers.

In the federal fiscal year 2016, the SHIP discretionary appropriation was $52.1 million. Of that total, ACL 

granted $48 million to states through a defined funding formula, which is based on the number of 

Medicare beneficiaries in each state or territory. The remaining $4.1 million supported administration of 

the SHIP program, which includes federal staff to provide oversight, training, and technical assistance; 

support contracts; and a grant to establish a national technical assistance center for the program.

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 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. 

Over the last 9 years, the Medicare beneficiary population grew 26 percent from 45.4 million (2008) to 

57.1 million (2016). Meanwhile, federal funding for the SHIP program grew 22 percent from $42.6

million (2008) to $52.1 million (2016). The table below depicts annual federal funding levels, which have 

been the same since 2014, and steady growth in the Medicare population, which is expected to continue 

to grow at an increased rate as the Baby Boomer Generation ages into Medicare.

Chart 1. Medicare Population and SHIP Discretionary Appropriation Comparison, 2014-2016

2014 2015 2016

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

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

Funding Annual Growth Rate 0% 0%

Medicare Population (millions) 54.1 55.6 57.1

Medicare Population Annual Growth 

Rate 3% 3%

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

this report.

Congress transferred the SHIP program from the Centers for Medicare & Medicaid Services (CMS) to the 

Administration for Community Living (ACL) through Public Law 113-76, the Consolidated Appropriations 

Act of 2014. This transfer reflects the synergies between SHIP and other networks that ACL funds and 

supports, such as the State Units on Aging and Area Agencies on Aging (AAA). At the community level, 

many SHIPs rely on local partnerships with AAAs for support and management of counselors and to 

conduct outreach activities. In addition, over 50 percent of the SHIPs are co-located with the Senior 

Medicare Patrol (SMP) program, which is a related volunteer-based program funded by ACL that 
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provides outreach and education to Medicare beneficiaries to prevent, detect, and report Medicare 

fraud, errors, and abuse. 

A full list of SHIP grantees and the 2016 grant year funding amounts can be found in Appendix A. 

2016 Program Overview

Activities and Outcomes

SHIPs serve as key sources for Medicare information and assistance in the community. They do so by 1) 

providing individualized personal assistance to people with Medicare, their families, and caregivers; and 

2) conducting outreach activities to inform the general public about Medicare and other related health 

coverage options.

Individual Contacts

In 2016, SHIPs provided one-to-one assistance to more than 3.2 million Medicare beneficiaries, their 

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

healthcare questions or issues. This included helping people with Medicare understand their health 

insurance options, providing enrollment assistance, and navigating complicated billing or benefit 

coordination issues.

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; 

 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. 

These contacts often involve multiple subjects and require 

extensive counseling time and assessment to properly 

address questions and issues. Chart 2 details the average 

time spent on individual SHIP interactions. There has been 

a slight increase in each of the last three years, reflecting the continuous need for and complexities of 

SHIP counseling. The average time spent on individual SHIP interactions was 28 minutes in 2014, 29 

minutes in 2015, and 30 minutes in 2016. 

Outreach Activities

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

Medicare and to help people make informed healthcare decisions. In the 2016 grant year, SHIPs 

educated almost 4 million people at more than 71,000 events including in-person presentations and

health or senior fairs. In addition, SHIPs hosted nearly 13,500 enrollment events to provide in-person, 

one-on-one assistance to help people compare Medicare plans and complete enrollment applications. 

28

29

30

27

28

29

30

31

GY 2014 GY 2015 GY 2016

Chart 2. Average Minutes Per 

SHIP Contact
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Presentations

SHIPs tailor their presentations to the audience and highlight important dates and timely details 

about Medicare. Throughout the year, SHIPs target those who will soon reach Medicare eligibility in 

events known as “Medicare Boot Camp,” “Medicare 101,” or “New to Medicare.” These events 

focus on the basics of Medicare enrollment and 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. In the 2016 grant year, SHIPs conducted 

approximately 42,400 interactive presentations that reached over 1.28 million people.

Health and Senior Fairs

SHIPs raise awareness of their services by participating in community health fairs, business expos, 

and conferences to offer assistance to people with Medicare, their families, and caregivers. SHIPs 

participated in over 15,300 fairs in the 2016 grant year. 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

From September through midDecember, SHIPs are busy preparing 

for and holding enrollment events to 

help beneficiaries compare their 

Medicare plan options. Many SHIPs 

mail postcards and letters to previous 

clients to remind them to make an 

appointment with a SHIP counselor or 

attend a scheduled enrollment event. 

During a plan comparison 

appointment, or at an enrollment 

event, a SHIP counselor meets one-onone with a beneficiary to enter their prescription drugs into the 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 their behalf through 

the Medicare Plan Finder. However, if the beneficiary wants more time to consider the decision, the 

SHIP counselor can print materials for their later review. The beneficiary can contact the SHIP 

counselor for enrollment assistance at a later date or contact the insurance plan directly to enroll.

During the 2016 grant year, SHIPs hosted nearly 13,500 enrollment events, reaching over 187,000 

people with Medicare, their families, or caregivers. Approximately 65 percent of attendees at these 

events chose to enroll in a Medicare health or drug plan with the assistance of a SHIP counselor.

Frequently Reported Challenges with Medicare

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

policies. This section describes some of these challenges, including enrollment issues, coverage 

transitions, the annual Medicare plan review, provider and network adequacy, and Medicaid improper 

billing. In addition, the SHIPs have provided ACL with their recommendations for addressing some of the 

challenges identified. Each of these issues and the associated recommendations, where applicable, are

detailed briefly below. 

2014 2015 2016

Presentations 38,130 39,749 42,163

Booth at Health Fair 15,987 18,535 15,333

Enrollment Events 10,588 11,418 13,372

0

10,000

20,000

30,000

40,000

50,000

Chart 3. Number of Outreach Activities
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Enrollment Issues 

SHIPs report a variety of concerns beneficiaries encounter with enrollment, including issues related to 

notices, late enrollment penalties, and Internal Revenue Service (IRS) penalties.

Notices

SHIPs often hear from Medicare beneficiaries that missed their Initial Enrollment Period (IEP) to 

enroll in Medicare. Currently, the Social Security Administration (SSA) only sends IEP notices to 

those who are both drawing a Social Security benefit and nearing Medicare eligibility. As such, SHIPs 

often hear from people that did not receive notification of their IEP because they were not yet 

drawing Social Security benefits when they became eligible for Medicare. As a result of this lack of 

notification, many beneficiaries miss their initial opportunity to enroll in Medicare and need help to 

find coverage options to fill the gap before the next enrollment period. 

Late Enrollment Penalties

Often as a result of the lack of notification explained above, SHIPs are asked to explain late 

enrollment penalties, which differ for each part of Medicare. When Medicare beneficiaries miss an 

enrollment period they face coverage gaps and increased costs. Beneficiaries regularly ask for help 

navigating the difficult situations created by the late enrollment penalties. SHIPs assist by counseling

beneficiaries about their options for securing Medicare coverage while minimizing coverage gaps 

and late enrollment penalties. 

IRS Penalties

SHIPs receive questions about challenges beneficiaries face when IRS penalties are assessed due to 

unexpected, retroactive enrollment in Medicare Part A. This can happen when someone waits to 

enroll in Medicare until after age 65 and contributes to a Health Savings Account (HSA) during the 

six-months prior to enrolling in Medicare. In this situation, the SSA processes the Part A enrollment 

with an effective date retroactive for up to six-months. Because the IRS does not allow contributions 

to an HSA while enrolled in Medicare, the individual owes a penalty for contributions made to the 

HSA during the six-month period for which they were retroactively enrolled in Medicare Part A. 

SHIPs have identified and shared with ACL the following recommendations to address enrollment

challenges. 

1. Notices: Enable the Social Security Administration to send enrollment notices to all those 

nearing Medicare eligibility regardless of Social Security benefit status. 

2. Late enrollment penalties: Limit assessment period look back and length of years the penalty 

applies.

3. IRS penalties: Allow beneficiaries to opt-out of the 6-month Medicare Part A automatic, 

retroactive enrollment. 

Coverage Transitions

SHIPs commonly counsel people with Medicare about the rules that define which coverage pays first (or 

second), as well as the consequences for not acting within certain timeframes during transitions in 

coverage. These rules differ slightly for each type of coverage, the size of the employer group, and the 

age of the beneficiary. Beneficiaries frequently contact SHIPs for assistance with challenging coverage 

transitions, including those involving employer, Marketplace, and Medicaid-expansion coverage.
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Employer Transitions

SHIPs are often asked to help people transition from employer coverage into Medicare. These 

situations are complicated by the type of coverage involved, the beneficiary’s employment status, 

and the size of the employer. Employer human resource departments often are unable to assist 

their beneficiaries with this transition; therefore SHIPs proactively target employer groups with 

messaging about Medicare eligibility and how Medicare coordinates with employer and retiree 

coverage. SHIPs work with human resources staff, offering one-on-one assistance to address specific 

questions and concerns to help people navigate this transition and avoid the enrollment challenges 

described above. 

Marketplace Transitions

SHIPs report that Marketplace enrollees face two common challenges: (1) failing to disenroll from 

the Marketplace plan after becoming eligible for Medicare, and (2) tax penalties related to advance 

payment of premium tax credits. For example, a new Medicare beneficiary may like his or her

Marketplace plan and want to keep it after enrolling in Medicare. However, once eligible for

Medicare, the beneficiary is no longer able to receive advanced premium tax credits to help pay for 

the plan, but may not realize it until tax time. Beneficiaries in this situation may have to repay some 

or all of their advanced premium tax credit and may also face Medicare late enrollment penalties 

and/or delayed enrollment in Medicare.

Medicaid-Expansion Transitions

When Medicare beneficiaries transition from Medicaid-expansion coverage into Medicare, they 

often experience challenges related to reduced Medicaid coverage because individuals who are 

eligible for Medicare are not eligible for Medicaid coverage under the adult group (expansion 

population). An increasing number of Medicaid beneficiaries in the adult group are being affected by 

this limitation. While Medicare eligibility disqualifies individuals from being eligible under the 

Medicaid expansion group, many will be able to retain eligibility for Medicaid under another 

eligibility group and/or be eligible for the Medicare Savings Programs (MSPs), which provide 

assistance with at least Medicare premiums, and in many cases, Medicare Part A and Part B costsharing.

Medicare eligibility disqualifies individuals from Medicaid adult group coverage because of differing 

income and asset eligibility requirements, which often results in higher premiums and increased 

cost-sharing. Medicaid Expansion considers Modified Adjusted Gross Income with no asset limit, and

Medicaid for Medicare beneficiaries considers gross income and imposes asset limits. 

SHIPs have identified and shared with ACL the following recommendations to address coverage 

transition challenges. 

1. Marketplace transitions: Require Marketplace plan to send a notice to the insured, and continue 

to support Centers for Medicare & Medicaid Services (CMS) penalty forgiveness and letters to 

Medicare beneficiaries also enrolled in Marketplace plans. The CMS letters advise Medicare 

beneficiaries of their options, offer a time-limited opportunity for penalty forgiveness for 

Medicare late enrollment, and include SHIPs as a contact resource for help with questions or 

concerns.

2. Medicaid expansion transitions: Treat income among Medicare Savings Programs the same as 

Medicaid Expansion and consider only Modified Adjusted Gross Income. Additionally, remove 
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asset limit for Medicare Savings Program to match Medicaid Expansion. Examples include the 

following:

a. Multiple states have used authority under section 1902(r)(2) of the SSA to apply less 

restrictive income and asset methodologies than those used in determining eligibility for 

Medicare Savings Program or other eligibility groups. By exercising this authority, states 

can facilitate alignment of the eligibility rules between Medicare Savings Program and 

Medicaid expansion group (adult group), which can ease the transition of beneficiaries 

from the expansion group to Medicare Savings Program when they become Medicareeligible.

b. A number of states also have used section 1902(r)(2) to provide Medicare Savings 

Program to a greater portion of Medicare-eligible individuals losing coverage under the 

Medicaid expansion group by disregarding certain amounts or types of income and 

assets of a beneficiary, his or her spouse or other family members in determining 

eligibility for coverage under Medicare Savings Programs or other non-MAGI eligibility 

groups.

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. Each year, Medicare plans optimize their offerings and may change their

coverage, provider or pharmacy networks, drug formulary, and cost-sharing. Plans are required to mail 

their members a packet annually that details all the changes, as well as a document outlining their 

policy. These legal documents are hundreds of pages long and it can be difficult for even the most 

dedicated Medicare beneficiary to explore or understand them in their entirety.

Medicare Plan Finder

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. Many SHIPs also teach classes to train people with Medicare to 

use the Medicare Plan Finder to compare plans themselves. 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. Compounding the challenge, the Plan Finder uses terminology 

that requires a high level of insurance health literacy to navigate coverage pages, locate provider 

networks, and review drug coverage and restrictions that can impact access to necessary 

medication. 

The SHIP network has shared the following recommendations with ACL and CMS to address the 

challenges with the Annual Enrollment Period and the Medicare Plan Finder: 

1. Conduct focus testing with beneficiaries who have low health insurance literacy and/or limited 

technology skills to help identify possible enhancements to the plan finder to make it easier for 

beneficiaries to navigate on their own. 
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2. Consider reorganizing the information on the plan finder to make it quicker and easier for 

beneficiaries to identify the most important pieces of information to help them compare plans 

and make informed choices.

Provider and Network Adequacy

Beneficiaries often report challenges finding providers who are accepting new Medicare patients. This is 

most frequently reported by beneficiaries in rural areas who are seeking new primary care physicians. 

As such, SHIPs often help Medicare beneficiaries find providers accepting new Medicare patients, 

particularly when they’re initially joining Medicare, moving to another area, or trying to find a new 

primary care doctor. This is a more prevalent complaint among beneficiaries who get their Medicare 

Part A and B benefits through Original Medicare (also referred to as Traditional Medicare). 

In contrast, beneficiaries who get their Medicare health benefits through private insurance plans (called 

Medicare Advantage) are more likely to face challenges with proximity, rather than availability 

(particularly outside urban centers with large medical systems). Even though CMS requires Medicare 

Advantage plans to meet network adequacy requirements, beneficiaries may be required to travel many 

miles to see a general practitioner or a specialist.

SHIPs shared the following recommendations with ACL to address the challenges with provider and 

network access: 

1. More regularly update the Physician Compare Tool on Medicare.gov to give beneficiaries access 

to the most up-to-date information available to assist with physician selection. 

2. Consider adjusting the proximity standards and/or requirements of the Medicare Advantage

plans to include providers within closer proximity to beneficiaries. This would provide 

beneficiaries with greater choice and easier access to providers. 

SHIP Innovations

SHIPs consistently seek efficiencies and reported the following examples of innovative partnership and 

technology usage.

 Tennessee SHIP Partners with Pharmacy Schools for Part D

SHIP partners with the two university pharmacy schools located in Nashville at Belmont and East 

Tennessee State, and Lipscomb University pharmacy school in Johnson City. The pharmacy 

students offer unique skills to identify potential drug interaction problems while reviewing 

beneficiaries’ medication lists before entering them in the Medicare Plan Finder. In 2016, TN 

SHIP trained 102 students to host outreach and enrollment events, assist with Medicare drug 

plan comparisons, and to complete Extra Help applications. The pharmacy students donated 304 

hours of service during three outreach events. Additionally, the pharmacy students provided 

nearly 150 hours of direct services through 393 one-to-one counseling sessions with Medicare 

beneficiaries.

 Georgia SHIP (GeorgiaCares) and Fort Valley State University Go Mobile

GeorgiaCares partners with Fort Valley State University to use its mobile technology unit (MTU). 

The MTU is a truck that houses 20 computer stations and presentation equipment. Fort Valley 

allows each GeorgiaCares local office to use the truck for a dedicated enrollment event, and 

parks the MTU in an accessible area, such as a pharmacy parking lot. At the enrollment event, 
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GeorgiaCares staff gives a brief presentation, helps beneficiaries compare plans online, and 

assists with enrollments (if requested). In 2016, through these partnerships an additional 221 

beneficiaries received SHIP counseling during 12 outreach and education events. The events 

were held in both rural and urban counties as follows;

 Rural: Gordon County Division of Family and Children Services (Gordon County), Belk’s 

Department Store (Stephens County), LaGrange Senior Center (Troup County), Williams 

Road Church of Christ (Sumter County), Candler County Senior Center (Candler), The 

Plaza (Thomas County), and

 Urban: Mt. Vernon Baptist Church (Fulton County), Second Baptist Church (Houston 

County), Peabody Apartments (Richmond), St. Marks Tower (Glynn County), and 

Madison County Recreation Department (Madison County).

 New Mexico SHIP offers Webchat 

The New Mexico SHIP launched a webchat option for beneficiaries through the program’s 

website. Beneficiaries can chat directly with a SHIP Counselor for Medicare information. In 

addition to giving beneficiaries real-time access to SHIP counselors, it is a great option for 

caregivers or children who live out of the state to contact SHIP with Medicare questions for their 

loved ones. The New Mexico SHIP completed 1,575 chats in 2016.

 Nebraska SHIP partners with Extension Service

The University of Nebraska-Lincoln (UNL) Extension Service is well-known, trusted source based 

on its history providing agricultural and family development programs in rural communities. 

SHIP partnership with UNL Extension extends SHIP outreach to audiences the program might not 

otherwise reach in rural areas. In 2016, eight (8) Extension educators were certified SHIP 

counselors. They provided 851 one-to-one counseling sessions and hosted 58 outreach and 

enrollment events. 

Administration Overview

2016 Program Initiatives 

Shortly after SHIP moved from CMS to ACL, ACL embarked on a full program evaluation, including an 

assessment of the state of the program, its strengths, and recommendations to better deliver on the 

program mission and goals in the future. ACL evaluated the results and focused on the following items in 

2016:

Strategy Development

The SHIP evaluation revealed that while the SHIP network had a dedicated and mission-driven 

workforce, the long-term strategy for the program was unclear. In the absence of a formal strategy, 

grantees made strategic decisions based on the information available, which led to a variance in 

priorities across the SHIP network. To address these variances and to bring the SHIP network together,

ACL developed (with help from SHIPs and other stakeholders) a new mission and four strategic themes 

highlighting focus areas and goals for the program that were communicated to the network via the 2017 

SHIP Funding Announcement. Future grants will be monitored and evaluated using these new strategic 

themes and goals.
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Mission To empower, educate, and assist Medicare-eligible individuals, their families, and 

caregivers through objective outreach, counseling, and training, to make informed 

health insurance decisions that optimize access to care and benefits

Strategic Themes Goals

Service Excellence  Consistently and confidentially provide accurate, objective, and 

comprehensive information and assistance. 

 Promote awareness, knowledge, and visibility of the program. 

Capacity Building  Recruit, train, and retain a diverse, sufficient, and effective 

workforce at all levels. 

Operational Excellence  Develop and strengthen the program structure and organization, 

including policies, processes, and procedure, to enable effective and 

efficient operations. 

Innovation  Promote adaptable and sustainable processes and activities to 

position the SHIP for changes in the programmatic landscape. 

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 CMS to provide technical assistance, support, and communication to the SHIPs on 

Medicare, Medicare changes, and beneficiary issues and questions. Since the transfer of the SHIP from 

CMS in 2014, ACL has worked closely with CMS to continue and strengthen this partnership. One 

example of these partnership activities includes collaboration with CMS Regional SHIP Liaisons. These 

liaisons assist SHIPs with complex Medicare beneficiary cases, provide training and Medicare technical 

expertise for SHIPs, and support local SHIP community outreach and education opportunities.

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.

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.
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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.

SHIP Data System

SHIP programmatic dollars fund the SHIP National Performance Reporting (SHIP NPR) system, which is a 

web-based data system SHIPs use to report their work. This system provides real time data on the work 

that SHIPs are completing nationally and allows ACL to monitor activities and provide immediate 

technical assistance, if needed. The comprehensive, timely, and accurate data contained in SHIP NPR 

supports ACL’s ability to assess the performance of the SHIP network and individual grantees in meeting 

goals of the program, as well as identify target areas for performance improvement. 

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 

will begin with the 2017 SHIP grant year and will last three years. 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.

SHIP National Training Meeting

SHIP programmatic dollars fund an annual national training for SHIPs and Senior Medicare Patrol (SMP) 

grantees 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 and hone 

new skills to strengthen the programs’ outreach efforts and the involvement of volunteers. This meeting 

also allows for networking and sharing of best practices with grantees in other states and territories, ACL 

staff, national partners (such as CMS), and the SHIP TA Center staff.

In the 2016 grant year, more than 300 people registered for the conference. Presenters included staff 

from ACL, CMS, HHS Office of Inspector General (OIG), national partners, and SHIP and SMP staff. Major 

topics included grants management; volunteer management (recruitment, retention, and training); 

Medicare’s Social Security Number Removal Initiative (SSNRI) regarding new Medicare cards being sent 

starting in 2018; and sharing of best practices on a myriad of topics related to SHIP work. The overall 
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score of the individual participant evaluations rated the conference as very helpful and informative 

(overall rating of 3.6 out of 4).

Looking Ahead

In an effort to continue quality improvement and successful programmatic management, ACL is working 

on a number of projects, in conjunction with SHIP stakeholders, to provide future enhancements to the 

program with a specific emphasis on improving program management and the ability to evaluate and 

measure program effectiveness. A few of these projects are highlighted below. 

Performance Measure Improvement

With participation from a varied stakeholder group, ACL revised SHIP performance measures to align 

with the newly developed mission, vision, and strategic objectives. The new performance measures will 

illustrate each SHIP’s reach relative to the Medicare population in their state. In addition, the new 

performance system uses a five-point Likert scale enabling comparison of performance relative to other 

SHIPs. The newly developed performance measures were implemented with the FY 2017 SHIP grant 

awards and will provide ACL an opportunity to evaluate the effectiveness of each program as well as the 

program as a whole nationally.

Development of New Data System

In September 2016, ACL awarded a contract to develop, implement, and operate a new SHIP data 

system with the goal of further improving grantee’s performance measurement abilities. The new 

system will provide more flexibility in reporting and data analysis than the current SHIP data system, and 

is specifically designed to support the work of SHIPs in the next decade. 

Additionally, the new system will connect with the Senior Medicare Patrol’s (SMP) data system, allowing 

the two programs to share data and creating efficiencies for the grantees who manage both programs

(currently 28 of the 54 grantees). ACL has continuously engaged stakeholders—including SHIP directors, 

ACL-funded resource centers, contractors and IT experts—throughout the creation of the system, with 

the goal of developing a system that is conducive to the needs of the end user, while also meeting the 

government’s need for an effective performance management system. The system, currently known as 

STARS (SHIP Tracking And Reporting System), went live in May 2018. 

Volunteer Risk and Program Management (VRPM)

SHIPs expend significant time and resources to professionalize and manage their counselor workforce, 

many of whom are volunteers. To enhance grantee efforts, ACL revised its existing Volunteer Risk and 

Program Management (VRPM) policies and procedures to incorporate SHIP grantees. The purpose of the 

VRPM policies is to enhance the quality, effectiveness, and safety of the program services through the 

provision of guidance and direction to program staff and volunteers. The polices are intended to support 

internal program management and support the mission of the program, fostering the ethical, 

productive, and rewarding engagement of volunteers. These policies and procedures have been 

successfully used by ACL’s SMP grantees since 2009.In FY 2017, SHIPs must begin planning and 

incorporating VRPM at the local level. SHIPs will use the VRPM framework which includes policies and 

procedures, workplace rules, and prohibitions to bring about the best outcomes for volunteers and 

beneficiaries. SHIPs retain the flexibility to customize policies based on local needs. 
14

Appendix A – FY 2016 State Grant Funding Amounts

2016 State Health Insurance Assistance Program Grant Awards

Project Period April 1, 2016 – March 31, 2017

Grantee Name State Federal Grant 

Award

Alaska Department Health & Social Services AK $251,057 

Alabama Department of Senior Services AL $881,268 

Arkansas Insurance Department AR $599,446 

Arizona Department of Economic Security AZ $840,395 

State of California, Department of Aging CA $4,776,715 

State of Colorado - DORA CO $601,830 

State of Connecticut Department on Aging CT $547,823 

District of Columbia Office on Aging DC $152,732 

Delaware Department of Insurance DE $200,984 

Florida Department of Elder Affairs FL $2,815,107 

Georgia Department of Human Services GA $1,145,384 

Guam Department of Public Health and Social Services GU $42,914 

State of Hawaii Department of Health HI $248,387 

Iowa Insurance Division--SHIP IA $756,340 

Idaho Department of Insurance ID $384,430 

Aging, Illinois Department on IL $1,515,119 

Indiana Department of Insurance IN $868,219 

Kansas Department for Aging and Disability Services KS $565,264 

Kentucky Department for Aging and Independent Living KY $839,652 

Insurance, Department of LA $659,339 

Massachusetts Executive Office of Elder Affairs MA $1,035,978 

Maryland Department of Aging MD $756,515 

Maine Department of Health and Human Services ME $431,762 

Michigan Department of Community Health MI $1,595,545 

Minnesota Board on Aging MN $1,021,318 

State of Missouri Department of Insurance MO $914,939 

Mississippi Department of Human Services MS $592,115 

Montana Department of Public Health & Human Services MT $611,568 

North Carolina Department of Insurance NC $1,493,209 

North Dakota Insurance Department ND $268,186 

Nebraska Department of Insurance NE $456,409 
15

NH Department of Health and Human Services NH $283,540 

New Jersey Department of Human Services NJ $1,039,285 

New Mexico Aging & Long-Term Services Department NM $433,907 

Nevada Aging and Disability Services Division NV $408,886 

New York State Office for the Aging NY $2,538,553 

The Ohio Department of Insurance OH $1,927,772 

Oklahoma Insurance Department OK $604,983 

Oregon State Dept. of Consumer and Business Services OR $577,601

Pa Dept. of Aging Health & Consumer Education PA $2,169,481 

Ombudsman Office for the Elderly Commonwealth PR PR $822,324 

RI Dept. of Elderly Affairs RI $267,489 

Lieutenant Governor's Office on Aging SC $761,186 

South Dakota Department of Social Services SD $343,932 

TN Commission on Aging and Disability TN $1,069,586 

Texas Department of Aging and Disabilities Services TX $2,613,306 

Utah Department of Human Services UT $352,016 

Dept. for Aging and Rehabilitative Services VA $999,295 

Government of the Virgin Islands VI $45,887 

Vermont Agency of Human Services VT $239,358 

Washington State Office of the Insurance Commissioner WA $880,099 

Wisconsin Department of Health Services WI $1,000,455 

West Virginia Bureau of Senior Services WV $466,745 

Wyoming Department of Insurance WY $318,717