Medicare Prescription Drug Plan
Low Income Subsidy
The Application Process
Roy Trudel, CMSONational Eligibility Workers Call
November 23, 2004
Low Income SubsidyApplication Process
About 11 million potential LIS benes
--- Goals ---
• Avoid confusion for beneficiaries
• Process initial 11 M applications
• Foster national consistency
• Take burden from States
Where will beneficiaries apply?
At SSA
- Field offices
- Mail in
- On the internet
- Over the telephone
…and
Where will beneficiaries apply?
At other outreach locations such as:
Senior centers Offices on Aging Health care provider sites Others…..
Note – “outreach” application sites will use the SSA Application/Determination process
…and
Where will beneficiaries apply?
At State Medicaid Agencies
Using the SSA application/process
Using a State’s own application/process
Low Income SubsidyApplication Process
Does it matter who determines eligibility?
Yes!and
No!
Note – this is different from
who “takes the application”
Low Income SubsidyApplication Process
SSA . . . using nationally consistent
LIS eligibility standards
based on SSI concepts.
State Medicaid Agencies . . .
Who makes the eligibility determination?
Low Income SubsidyApplication Process
Whoever makes the initial determination . . .
• Conducts the periodic redetermination
• Conducts eligibility appeals
Low Income SubsidyApplication Process
SSA . . .
Using a national SSA process as determined by the SSA Commissioner
State Medicaid Agencies . . .
Using that State’s Medicaid redetermination and appeals process
Periodic redeterminations or eligibility appeals
Timeline
• SSA will be ready to process LIS applications in July 2005
• Ambitious Goal:
– 50% of LIS-eligible beneficiaries by September 30, 2005
– 90% of LIS-eligible beneficiaries by November 30, 2005
SSA’s Application
Development:
• The LIS application is key to program success
• Focus group and cognitive tested
• Many iterations
• Now in final clearances
SSA’s Application
• Has a cover letter
• Large type
• White space
• Embedded examples - “how to” fill out Qs/As
• Spanish version
• Fact sheets in 14 languages
• SSA field offices have bilingual staffs
SSA’s Application
SSA’s process is automated.
• Application optically scannable
• Beneficiary attests to information
• Data matches for verification
• Some questions “kick out” and SSA contacts the individual for details.
SSA’s Application
• Based on a hierarchical process
• Based on SSI income & resources concepts
• Applicants and spouses use same form; i.e.; apply together
SSA’s Application
• Starts with a screen-out question
• If deemed eligible, don’t file an application
• Automatically enrolled for the subsidy
SSA’s ApplicationResources
• Broad resources screen-out question
• Resources over $11,500 (single) or $23,000 (married)?
• Yes – Don’t complete application; not eligible
• No or not sure – keep going
SSA’s Application
Resources cont’d
Value of –
• Bank accounts
• Stocks, bonds, mutual funds, etc.
• Cash on hand
SSA’s Application
Resources cont’d
• Life insurance policies – face value $1,500 or more?
• Money set aside for burial?
• Non-home real estate?
SSA’s Application
Family Size
• Income standard based on family size
• Only applicant’s & spouse’s income counted
• Family – Relatives living with applicant who get at least one-half support from applicant
• Relative – Blood, marriage, or adoption
SSA’s Application
Income
• Unearned income
– Social Security
– Railroad Retirement
– Veterans
– Other stuff
– In-kind support & maintenance
SSA’s Application
Income cont’d
• Earned Income
– Wages, salary
– Self-employment
• Impairment-related work expenses (IRWEs)
SSA’s Application
SSA is developing a quality assurance process
• Look at the effectiveness of the process
• Inform future eligibility operational policy decisions
SSA’s Application
Taking the Burden from States
• SSA willing and able to process applications taken by states
• Entirely voluntary for states
• States would use SSA’s application form
• States could submit applications to SSA’s data processing center in Wilkes-Barre, PA, or via Internet
SSA’s Application
• CMS encourages states to use the SSA process
• States would function as intake source
• SSA would own the redeterminations and appeals for applications it processes
• The big question – Would this fulfill the law’s requirement that states make eligibility determinations?
SSA’s Application
• Lastly – (and importantly!)
• SSA is only involved in LIS eligibility.
• SSA is NOT involved in enrolling beneficiaries into a Medicare Prescription Drug Plan.
SSA’s Outreach
• Massive Outreach plans
– Letters/notices
– Grass roots
– Media
The “deemed” eligible will get “good news” letters instead of outreach to apply.
SSA’s Outreach
Messages:
• You may be eligible
• Apply w/SSA
• Apply early
• Apply via form, internet, phone, walk in
• Select a drug plan
SSA’s Training
• Planning for extensive training for
– State eligibility workers
– Community Based Organizations
– SHIPs
• Writing guides for “non-intake” types to be able to assist beneficiaries filling out application.
Timeline - What, me worry?• 10/4/04 – Comments due on CMS NPRM• Early 2005 – Publish final CMS rule• 3/1/05 – MPDP applications due to CMS• May/June 2005 – SSA begins LIS Outreach• 6/1/05 – CMS approves applications• 6/6/05 – MPDP bids due• 6/30/05 – SSA goal: process 50% apps.from LIS benes• 9/5/05 – CMS awards MPDP bids• October 2005 – CMS writes to beneficiaries to enroll• 11/15/05 – Initial open season enrollment begins• 11/30/05 – SSA goal: process 90% apps. from 90% LIS benes• 1/1/06 – Dual eligibles lose Medicaid drug coverage