Beginning Training for MIPPA Outreach Coordinators

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Beginning Training for MIPPA Outreach Coordinators

• The Basics you need to know.

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What is MIPPA?

• M edicare
• I mprovements for
• P atients and
• P roviders
• A ct of 2008

The Act had many important components, including
changing the eligibility rules for Medicare
Savings Plans and Extra Help, and providing
grants to State SHIPs, AAAs, and ADRCs to do
outreach and increase enrollments
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Key is finding the right folks

• For the Part D LIS (Low Income Subsidy)
• For the Medicare Savings Plans (MSPs also
  called QMB, SLMB, and SLMB)
• For SeniorCare Level One
• Make sure they know about changes in eligibility
  requirements
• Help them to enroll
• Document and report applications

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Agenda

• Basic structure of Part D
• Overview of LIS (Extra Help)
• Overview of SeniorCare
• Overview of MSPs
• The Preventive Benefits of Medicare
• How to help with applications
• What needs to be reported

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Standard plan for 2011
Catastrophic coverage after 6447.50 in total
drug costs
2840 Coverage gap begins
4550 Out of pocket Threshold
50 Discount on Brand Name Drugs 7 on Generics
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The Coverage Levels for Part D in 2012
Catastrophic Coverage After total drug costs of
6657.50 You pay 5 The plan pays 95
THE COVERAGE GAP You pay 50 on Brand Names and
get 14 of the cost of generics covered to Out of
Pocket Threshold of 4,700 for your costs
discounts in donut hole
You pay about 25 up to 2,930 in TOTAL DRUG
COST
Part D Plan Pays 50-75
Initial deductible 320 ( plan pays none)
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Help for Tough Times Low-Income Subsidy

• 3 groups of people have LIS
• Full dual eligibles (have both full MA card
  services and Medicare) automatically have full
  extra help.
• MSP (Medicare Savings Program) eligibles have
  full extra help.
• Extra help through Social Security. The SSA has a
  program to help with D costs. You can have full
  or partial extra help under 3.
• Once you have LIS, it lasts until Dec. 31st of
  the calendar year. If you have LIS in July of
  2011, you should also be re-deemed through
  2012.

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Low Income Subsidy Extra HelpNote There may
be ways to help you qualify for extra help even
with higher income. Call your Benefit Specialist
Extra Help Co-pays w/Monthly Income Generics Brand Names
907.50 individual/ 1,225.83 couple 1.10 3.30
1,225.13 individual/ 1,654.88 couple 2.50 6.30
1,361.25 individual/ 1,838.75 couple Deductible 63 15 co-insurance for Rxs
Assets for full LIS lt 8180 ind. Or lt 10,020 for a couple (s assume 1500 per person will be used for burial) Assets for partial subsidy are lt12,640 individual or lt 25,260 for a couple
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Part D and SeniorCare

• 30 to enroll for one year No asset limit
• Senior Care continues through 2012 as creditable
  coverage
• People CAN be enrolled in both programs if not on
  Medicaid
• MIPPA focus is on Level 1 of SrCare

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Why Level One Senior Care Matters

• For incomes at or below 17,424 individual or
  23,536 per couple
• In monthly terms, that is 1452 individual or
  1961 couple
• NO ASSET LIMITS so folks with just a bit more
  than would qualify for Extra Help, or folks with
  more assets than allowed can get help with
  SeniorCare

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SeniorCare v. Part D

• For folks who only qualify for the partial
  subsidy for Part D, SeniorCare level one by
  itself may actually cost them less money.
• Might want to refer them to Benefit Specialist to
  check it out.
• But folks who qualify for full LIS likely save
  more than with SeniorCare unless not all drugs
  are covered.

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MIPPA and LIS Changes

• Given tough times, renewed effort to find folks
  who qualify
• Their assets may have gone down
• The income limits go up annually
• Since 2010 two things dont count for LIS
• Cash value of life insurance policy
• Any in-kind support

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The ABCs of MSPs

• QMB (Qualified Medicare Beneficiary)
• Payment of Medicare Part A monthly premiums (when
  applicable).
• Payment of Medicare Part B monthly premiums and
  annual deductible.
• Payment of coinsurance and deductible amounts for
  services under both
• Medicare parts A and B.
• SLMB (Specified Low-Income Medicare Beneficiary)
• Payment of the Medicare Part B premium only.
• SLMB / QI (Qualified Individual Program)
• Payment of the Medicare Part B premium only.
• Individuals must apply every year for these
  benefits.
• Not available to those who qualify for any other
  kind of Medicaid.

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MIPPA and MSPs

• State Buy-In Programs can provide savings on
  premiums and cost sharing and even allow elderly
  without work credits to obtain Medicare
• Income limit of 1,225.13 single or 1,654.88
  for couple
• Asset limit has increased to the same as FULL
  subsidy LIS 6,600 for individuals or 9,910 for
  couples.
• Individuals may also be able to exclude an
  additional 1500 per person for burial expenses,
  but these funds must be set aside in a special
  way not the same as for LIS.
• (Cash value of life insurance policies still
  usually matters for MSP even though it no longer
  counts as an asset for LIS)

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Other Income Disregards Matter

• Remember that in considering income, you must add
  back in the 96.40 (or 110.50, or 115.50)
  being taken out of Social Security before checks
  arrive.
• But there is always a disregard of 20 a month of
  this unearned income which is not accounted for
  in the official limits.

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Other Income Disregards Matter

• Earned income is even more discounted.
• Subtract 65 a month and then divide by 2.
• So If in doubt file an application!

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When Do Medicaid Applications Count for MIPPA?

• Medical Assistance is an even greater benefit
  than Medicare Savings Programs (a type of
  Medicaid benefit as is SeniorCare)
• Categorically Needy
• Medically Needy
• Long Term Care Waiver
• MAPP (Medical Assist. Purchase Plan)

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Medicare Preventive Services

• Medicare Part B now covers many screenings with
  no deductible and no copay.
• Welcome to Medicare Exam during the first year
  you are enrolled in Part B.
• Annual Wellness Visit for basic check-up, risk
  assessment, medical history, and prevention plan
  development

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Other Preventive Services

• Bone Mass Measurements
• Cardiovascular Screenings
• Colorectal Cancer Screenings
• Diabetes Screening
• Flu Shot

• Glaucoma Test
• Hepatitis B Shots
• Pap Test and Pelvic Exam
• Pneumococcal Shot
• Prostate Cancer Screening
• Screening Mammogram

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Whats Up with LIS Lead Data?

• The MIPPA Law also required SSA to send to the
  States the info of all who applied for LIS (and
  were not already in the system) unless a box was
  checked NO.
• States are required to treat these leads as
  initiating an application for a Medicare Savings
  Program.
• Includes those denied LIS as well as those
  approved.

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What Happens Next

• Department of Health Care Access Acct.
• creates a Request for Assistance in CARES
• Sends a letter explaining MSPs and requesting
  more information to complete the application
• Shares data with Department of Health Services
  -- SHIP Director
• Letters sent to those denied LIS telling them
• where to call to see if other help is available

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Lead Data Sharing with Counties and BEC

• Starting April 2011, agreements were signed with
  most counties to have the data on people approved
  for LIS shared with them for direct follow-up.
• Info from counties not participating is instead
  shared with the CWAG Benefits Enrollment Center.
• If eligible for LIS, more likely eligible for
  MSPs (though not always).

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What to do with Lead Data?

• Assure confidentiality!
• EBS cannot make first contact because it would be
  a cold call
• May want to check CARES first
• Call to see whether client requests a referral to
  EBS
• Or call to provide screening for eligibility
  but be careful about how this is done

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How to File for LIS

• For MIPPA awardees, you can use a paper
  application from SSA, but the most timely
  processing occurs with online www.ssa.gov and
  click on the Chubby Checkers picture.
• If you believe the person will also qualify for
  an MSP complete a paper or online MA
  application as well. Dont rely on the
  automatic application from SSA to the State

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How to File for MSP

• Use the paper application for Medical Assistance
  and submit with appropriate documentation to your
  county agency.
• Or use www.access.wisconsin.gov to initiate an
  electronic application that may require further
  verification of information.
• Help your applicant be prepared with the needed
  documentation. Talk with your local Economic
  Support to work out the best process for timely
  consideration.

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How to Apply for SeniorCare

• Remember that only Senior Care Level 1
  applications count for MIPPA
• You can only report applications you know were
  submitted, not simply those you sent out for
  clients to complete.
• If you can get a phone or post card confirmation
  the application was sent in, you may then report
  it for MIPPA counts.

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If appropriate, do both!

• Even though all new dual eligibles (Medicare and
  Medicaid) and all MSP recipients are
  automatically enrolled in the LIS, this can take
  time.
• You also cannot count the MA or MSP application
  as automatically generating the LIS.
• So if you do both you can count both, and the
  LIS may get approved sooner.

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Dont rely on LIS for MSP

• Even though SSA will now share data about new
  applicants for the LIS who may be MSP eligible,
  dont rely on this process.
• If at all possible, assist with the MSP
  application also, rather than risk having the
  applicant get lost in the shuffle of follow-up
  letters and the need to refile much of the same
  information.

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Extra Care for SLMB

• At this point screening for SLMB (the highest
  income levels for MSPs) does not get done
  automatically in CARES.
• Make sure that you request a MANUAL screening for
  SLMB if you think this is appropriate or if the
  member is rejected for the other levels of MSP.
• Individual income between 1089-1225
• Couple income between 1471-1655

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Remember Recertifications!

• Although a new process for Administrative
  Recertifications has been approved for MSPs and
  some other benefits
• New folks must have one standard review
• Not all will qualify and only every other year
• Make sure folks understand about the need to
  recertify.
• SLMB will not get a letter generated by CARES

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What Counts?

• If recorded properly in SHIPtalk, the application
  numbers are generated automatically.
• How to report is covered in detail in the
  Wisconsin MIPPA 2010 Guidelines
• IAs are only asked to make it possible for
  applications to be reported

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What Counts?

• SeniorCare Level application (or renewal) can
  only be reported for MIPPA ONCE.
• If a person loses LIS or MSP and needs assistance
  to reapply, that restoration of the benefit can
  also be counted.
• The point is to identify those cases where
  someone connected with MIPPA outreach had a hand
  in making sure the application was completed.
• NO NEED TO VERIFY APPROVAL

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A Few Thoughts on Outreach

• Check the 2010 LIS Targeting data by zip code to
  see areas for focus.
• Think OUTSIDE the box and beyond the usual Senior
  Centers and Meal Sites
• Consider food pantries, trailer parks, churches
  (fish frys and festivals), county fairs, thrift
  stores, banks or pharmacies.

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Build Community Partnerships

• Educate those who are trusted advisors when
  Medicare beneficiaries may be admitting financial
  vulnerability (loan offices, clergy, parish
  nurses, service organizations, hospital admitting
  or billing offices)
• Ask them to refer to you or to help apply at
  www.benefitscheckup.org/mippa
• Applications made here from zip codes in your
  county will count for you!

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Questions?