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.

Alerts

The following daily alerts are generated for LIS applicants:

9057 MIPPA LIS App - Current MSP Elig but Not Current Medi-Cal Elig
9058 MIPPA LIS App - Current Medi-Cal Elig but Not Current MSP Elig
9059 MIPPA LIS App - Current Medi-Cal and MSP Eligible
9055 MIPPA LIS App - No Matching Record Found on MEDS
9056 MIPPA LIS App - Not Current Medi-Cal or MSP Eligible

Alert 9057 through 9059

For Alerts 9057-9059, refer to User’s Guide, Chapter 11, “9057 - MIPPA LIS APP - Current MSP Elig but Not Current Medi-cal Elig - Urgent,” page 10-38 for instructions.

Alert 9055 and 9056

For Alert 9055 and 9056, the Designated Clerical Staff follows the steps below:

Prints the “LIS Applications” report daily.
Completes file clearance procedures in CalSAWS and MEDS.
For individuals that already have an active or pending case:
1. Notifies assigned EW or unit by creating a Task. In the long description, enters “Urgent - LIS Alert 9055/9056”.
2. Adds Journal entry "Urgent - LIS Alert 9055/9056" in the case.
For individuals who do not have an active or pending case:
1. Sends the MC packet and CalFresh letter with the SCD 2269 coverletter which explains the client’s right to opt out of an MC and/or MSP evaluation.
2. Completes the Application Registration process.
  1. Use the APPLICATION-DATE shown on the [LIS1] screen.
  2. Select “Low Income Subsidy” from the Application Source drop down field.
  3. Assign the application to the appropriate caseload.
3. If the client does not return the packet, note that the client did not return the packet on the LIS Spreadsheet. Send the MC 239 A LIS DENIAL for failure to comply or whereabouts unknown, as appropriate.

Denial

A denial letter must be sent in the following situations:

LIS application date provides no benefit in terms of the beginning date of MC/MSP eligibility (for clients already active on MC/MSP)
The applicant does not return the packet or attempt to make contact,
Failure to provide verification.

LIS Notice of Action Usage

Notice of Action	Availability	Use
MC 239 A - LIS DENIAL	DEBS Forms	If an LIS applicant is already active on MC and/or MSP in CalSAWS, the LIS denial must be manually printed from DEBS Forms.
MC 239 A	CalSAWS	If the LIS applicant is determined ineligible for MC, the MC 239 A must be sent.
MC 239 K	CalSAWS	If the LIS applicant is determined to be ineligible for MSPs, use the MC 239 K. Note: If the applicant is also ineligible to MC, an MC 239 A must also be sent.

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.