9058 - MIPPA LIS App - Current Medi-Cal Elig but Not Current MSP Elig - Urgent

This alert is generated as a result of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) to notify the county 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 Medi-Cal but not MSP.

Action Required

Obtain all inquiry screens from the LIS database in MEDS.
Review the existing Medi-Cal case to determine if the applicant has been previously evaluated MSP:
- If YES and the information from the LIS screens does not show a change in circumstances, deny the MSP application as a duplicate using an appropriate NOA. No further action is required.
- If NO, determine if sufficient information is available to process the MSP application.
Request additional information and verification from the client, 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 MSP using the appropriate application date.
If the applicant is determined NOT ELIGIBLE, deny MSP and inform the client of the outcome of the evaluation with an appropriate NOA.

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

9058 - MIPPA LIS App - Current Medi-Cal Elig but Not Current MSP Elig - Urgent

Action Required

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