LIS Redeterminations and Redeeming

1
LIS Redeterminations and Re-deeming

• Marisa Scala-Foley Sara Duda
• ABC/NCOA
• August 14 and 15, 2006

2
Agenda

• Housekeeping
• Centers for Medicare Medicaid Services
  (CMS)/state re-deeming process
• Social Security Administration (SSA)
  redetermination process
• Next training PAPs

3
Re-deeming Background

• 3 groups of people with Medicare are deemed to
  be automatically eligible for the Extra
  Help/Low-Income Subsidy (LIS)
• Dual eligibles (those with Medicare and full
  Medicaid)
• Those enrolled in Medicare Savings Programs (MSP)
• Those with Medicare and SSI
• All automatically receive the full LIS

4
Re-deeming Process

• Based on information provided in July 6 SMD
  letter from CMS to State Medicaid Directors
• State sends MMA file to CMS in July with
  information about those currently receiving
  Medicaid, MSP and SSI-only beneficiaries
  receiving Medicare.

5
Re-deeming What happens to those still on the
July state file?

• Those still on their states Medicaid, MSP or
  SSI-only list will automatically be re-deemed
  eligible for LIS
• They do not need to do anything in order to keep
  receiving LIS
• Their eligibility will be automatically extended
  through December 2007.
• CMS will send letters to these beneficiaries
  letting them know that they will continue to
  receive LIS
• Separate letter will follow this fall if the
  persons plan either leaves the Medicare program
  or no longer is at or below the low-income
  benchmark for their region

6
Re-deeming What happens to those NOT on the July
state file?

• Those no longer on their states Medicaid or MSP
  will not be re-deemed for 2007
• They do have the option of submitting an LIS
  application on their own
• CMS will send letters to these beneficiaries
  letting them know that they will no longer
  automatically receive LIS and what they can do
• SSA and CMS are currently discussing whether each
  should send a letter to the person explaining
  that they are no longer deemed, or whether CMS
  should send one letter that includes the SSA LIS
  application.

7
Re-deeming What happens to those who show up in
state files after July?

• Beneficiaries who appear as subsidy-eligible on a
  State file for the first time between August and
  December 2006, will be deemed eligible for LIS
  from the earliest month of deemed eligibility
  through December 2007.
• State will report to CMS the people who are newly
  eligible for deemed status and CMS will auto
  enroll them into a plan.

8
LIS Redetermination

• According to MMA, SSA must conduct LIS
  redeterminations within the first 12 months of
  the Part D program
• In future years, SSA will establish a regular
  cycle for redeterminations
• This process will probably be more like the
  current SSI redetermination process where people
  are evaluated for likely change. Those more
  likely to have changes will be reviewed more
  often. Those less likely to have changes will
  get longer certification times.
• This current process is for those who applied and
  were approved for LIS before May 2006. This
  process begins in late August 2006.
• For people approved for LIS after May 2006, their
  first redetermination will be in August 2007
  (even though this is more than 12 months after
  their initial eligibility).

9
LIS Redetermination Letters

• SSA will send letters to 1.2 to 1.6 million LIS
  recipients explaining the review process and
  asking them to review the information SSA has on
  file for them
• Letters will list the following information about
  the beneficiary
• Income (work and other),
• Assets
• Household size

10
LIS Redetermination No change

• If the beneficiarys information is still the
  same or lower, then he/she does not need to do
  anything
• If the persons income has increased due to a
  Social Security COLA, they also do not need to
  report a change. SSA knows about the COLA and
  the COLA benefit will not cause someone to be
  over income for LIS.
• If SSA does not hear from someone, they will
  assume that persons situation has not changed.
• SSA will do a data match with other federal
  agencies to confirm that this is the case
• If the data match confirms that there has been no
  change, then the beneficiary will be re-certified
  LIS eligible for calendar year 2007.

11
LIS Redetermination Change in situation

• If the beneficiarys information has changed,
  then he/she should call SSA or send back the form
  enclosed with the letter within 15 days
• SSA will then send them a Redetermination
  Statement (SSA Form 1026-B) along with another
  statement of the information SSA has on record
  for them
• Beneficiary must complete and return the form
  within 30 days

12
LIS Redetermination Change in situation
(continued)

• On the statement the beneficiary must indicate
  how their situation has changed
• SSA will then make a redetermination of the
  beneficiarys eligibility based on the
  information he/she provides on Form 1026-B (as
  well as from the data match they do with other
  federal agencies)

13
LIS Redetermination Change in situation
(continued)

• If the beneficiary does not return the form
  within 30 days, SSA will contact them again by
  mail letting them know that they must return the
  form, or their LIS benefit will be terminated as
  of December 31, 2006
• If a persons LIS benefits are terminated, they
  can reapply.
• If the beneficiary discovers that there was, in
  fact, no change in their situation after all,
  there is a place on Form 1026-B for them to
  indicate that
• But they still have to return the form!

14
Resources

• Social Security Administration Policy Site (LIS
  redetermination) https//s044a90.ssa.gov/apps10/p
  oms.nsf/lnx/0603050000!opendocument

15
Next training

• Manufacturer Patient Assistance Programs (PAPs)
• Monday, September 25 1-230 EDT
• Tuesday, September 26 1-230 EDT

16
Questions?

• Contact
• Marisa Scala-Foley (202-479-6976 or
  Marisa.scala-foley_at_ncoa.org)
• Sara Duda (202-479-6678 or sara.duda_at_ncoa.org)