9057 - MIPPA LIS APP - Current MSP Elig but Not Current Medi-cal Elig - Urgent

This alert is generated as a result of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) to notify the EW that the Medicare Part D Low Income Subsidy (LIS) applicant must be evaluated for Medi-Cal and Medicare Savings Programs (MSP) eligibility.

The applicant was matched to the MEDS system and it was found that the client is currently receiving MSP but not Medi-Cal.

Action Required

Obtain all inquiry screens from the LIS database in MEDS.
Review the existing MSP case to determine if the applicant has been previously evaluated for Medi-Cal:
- If YES and the information from the LIS screens does not show a change in circumstances, deny the Medi-Cal application as a duplicate using an appropriate NOA. No further action is required.
- If NO, determine if sufficient information is available to process the Medi-Cal application.
Request additional information and verification about identity, citizenship, income, property, and/or disability evaluation, if necessary.
Compare and use the most beneficial application date found in CalSAWS and the [LIS1] and [LIS6] screens.
If the applicant is determined ELIGIBLE, approve Medi-Cal using the appropriated application date.
If the applicant is determined NOT ELIGIBLE, deny Medi-Cal and inform the client of the outcome of the evaluation with an appropriate denial NOA.

For more information, refer to MC HB Chapter 20: Medicare Coverage, Section Low Income Subsidy Applications.

9057 - MIPPA LIS APP - Current MSP Elig but Not Current Medi-cal Elig - Urgent

Action Required

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