Low Income Subsidy Applications

The Social Security Administration (SSA) is required to refer Medicare Part D Low Income Subsidy (LIS, also known as Extra Help) applicants to the state for Medicare Savings Programs (MSP) determinations with their consent. In addition to MSP, the State of California elected to also determine eligibility for full MC benefits. LIS applicants who require evaluation for MSP and/or MC eligibility are referred to the counties via MEDS daily worker alerts.

Application Date

The date of application for MC and MSP is the date the applicant filed for LIS Extra Help. This date is displayed on the [LIS1] screen in the APPLICATION-DATE field.

If there is already an existing MC/MSP application (pending or active), the application date that would be most beneficial to the applicant must be used.

If the applicant has applied for LIS more than once, all LIS application dates will appear on the [LIS6] screen. Each date is associated with the information received from SSA for that application. Information included in each application (income, resources, etc) must be used to help evaluate MC and/or MSP eligibility. The application date(s) not used for MC/MSP determination must be denied, either as duplicate application or for not meeting eligibility requirements.

Reminder: The QMB effective date has not changed. QMB eligibility begins the first day of the month following the month in which QMB is authorized in CalSAWS.

Processing Timeframe

Determination of MC/MSP eligibility must be completed within 45 days from the date the county receives the LIS alert. This date is normally one business day following the
COUNTY-REFERRAL-DATE shown on the [LIS1] screen.

Retroactive Benefits

LIS applicants can also apply for retroactive MC, SLMB and/or QI-1 benefits from the date of the LIS application. To request retroactive coverage, applicants must have medical expenses for the month(s) requested.

Note: The “Supplement to Statement of Facts for Retroactive Coverage/Restoration” (MC 210 A) must be completed as applicable.

Documentation

The result of MC and/or MSP eligibility determination must be clearly documented in the case and the LIS spreadsheet, including the reason of the denial if the LIS application is denied.

Business Process