MEMORANDUM

DISCUSSION:

The Medicare low income subsidy (LIS) provides extra help to individuals with limited income and resources to pay for Medicare Part D premiums, copayments, and the annual deductible.  Participants who are receiving Medicare and MO HealthNet, QMB, SLMB, SLMB-2 (QI-1) or SSI are referred to as dual eligible and deemed eligible to receive the subsidy.  MO HealthNet Spend Down participants who do not meet spend down liability are not considered to be receiving MO HealthNet.

This memo discusses the following:

DEEMED ELIGIBILITY FOR LIS
CHANGES IN COPAYMENT LEVELS
NO CHANGE IN LIS ELIGIBILITY
LOSS OF ELIGIBILITY FOR LIS
ROLE OF ELIGIBILITY SPECIALISTS

DEEMED ELIGIBILITY FOR LOW INCOME SUBSIDY

In July 2012, the Centers for Medicare & Medicaid Services (CMS) began the process to determine which participants are deemed eligible for low income subsidy for 2013.  Participants with active MO HealthNet, QMB, SLMB, SLMB-2 (QI-1) or SSI on the July 2012 State data files are deemed eligible for the low income subsidy for the calendar year of 2013.  Participants appearing on the State file match after July 2012 will also be deemed eligible from the earliest month of reported dual eligibility through December 31, 2013.

CHANGES IN COPAYMENT LEVELS

Participants deemed eligible for LIS for 2013 may have a change in their copay status for their Medicare Part D prescription plan if there has been a change in their income or resources.  This information is from the State data file and SSA.  In October, CMS will mail orange colored notices to all deemed eligible participants whose copay status is changing in 2013.  If the participant does not respond, coverage will continue under the current Medicare Part D plan in 2013 with the higher copay amounts.  If the participant does not want to keep the same plan, the participant can choose a new Medicare Part D plan for 2013.

NO CHANGE IN LIS ELIGIBILITY

Participants who continue to qualify for LIS without any changes will not receive a notice.

LOSS OF ELIGIBILITY FOR LIS

Participants previously deemed eligible for LIS in 2012 that did not appear on the July 2012 State data files are not deemed eligible for LIS for 2013 calendar year.  Their eligibility will end on December 31, 2012, unless they are approved for MO HealthNet, meet their MO HealthNet spend down liability, or are approved for QMB, SLMB, SLMB2 (QI-1) or SSI.

In September, CMS will mail gray colored notices to all participants who will lose their deemed eligibility for LIS as of December 31, 2012.  An application for LIS along with a postage paid envelope will be included with this notice so that individuals losing their deemed eligible status can apply directly to SSA to receive LIS after December 31, 2012.

ROLE OF ELIGIBILITY SPECIALISTS

Eligibility specialists should refer participants with questions about eligibility for LIS to the following resources:

• The Social Security Administration (SSA) at 1-800-772-1213 (TTY 1-800-325-0778);
• The SSA website at www.socialsecurity.gov/prescriptionhelp; and
• Community Leaders Assisting the Insured of Missouri (CLAIM) Program at 1-800-390-3330 or their website at www.missouriclaim.org.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Refer participants with questions concerning LIS to the resources provided in this memorandum.

HA