Medicare Prescription Drug Plan Low Income Subsidy The Application Process Roy Trudel, CMSO National Eligibility Workers Call November 23, 2004.

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