State Implementation of MMA

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Presentation transcript:

State Implementation of MMA Gale Arden Director Disabled and Elderly Health Programs Group, Center for Medicaid and State Operations

Part D: State Issues Coordination with CMS, SSA & States Transitioning Dual Eligibles Low-Income Subsidy Process Coordination with CMS, SSA & States Application process SPAPs Educating beneficiaries State Fiscal Analysis

Dual Eligibles: Transition to Medicare Prescription Drug Coverage Reaching Beneficiaries Protecting Special Populations Establishing Appropriate Safeguards Working with States Ensuring Continuity of Coverage Providing Extra Help

Strategy for Transitioning Duals Paper http://www.cms.hhs.gov/medicarereform/strategyforduals.pdf

Enrollment Process Ensure full-benefit dual eligibles transition to Part D plan by 1/1/06 This population will be randomly enrolled in a plan as follows: To PDP (if in FFS Medicare) or MA-PD (if in Medicare Advantage plan) Premium subsidized by Federal Government Able to opt-out of the plan Can choose another plan at any time, as long as they are full-benefit dual eligible

Low-income Subsidy – Challenges for States Preparing for low-income subsidy eligibility determinations Identifying full benefit dual eligible individuals Interacting with SSA Educating Medicaid recipients about upcoming changes Coordinating care With the PDPs and MA-PDs Formularies

Low-income Subsidy – Challenges for States Comprehensive financial impact on states Phasedown state contribution Increased administrative costs Retiree subsidy Others

Important Dates CMS mails notice to Deemed Eligibles May – June, 2005 CMS mails notice to Deemed Eligibles May – August, 2005 SSA mails application to Potential Eligibles Fall 2005 Beneficiaries choose Part D plan Can still apply for subsidy after enrolling January 1, 2006 Effective date of auto-enrollment of full-benefit dual eligible individuals June 2006 Effective date of facilitated enrollment of full-benefit dual eligible individuals

MMA Information for States MMA_States Listserv On www.cms.hhs.gov scroll down and click on “Mailing Lists” on the right yellow sidebar. Enter your information in the requested fields and choose the subscribe button for “MMA_States”. State MMA Information www.cms.hhs.gov/medicarereform/states Bi-monthly State Calls Generally, 1st and 3rd Mondays of each month Call-in info and agenda sent via MMA_States listserv

More MMA Information Beneficiary-Friendly Publications www.medicare.gov/publications Outreach Toolkit www.cms.hhs.gov/partnerships/tools/materials/medicaretraining/MPDCoutreachkit.asp Information Kit: Condensed version Request via email: bspgtraining@cms.hhs.gov MMA Q&A Submit questions: http://mmaissuesform.cms.hhs.gov Browse answers: http://www.cms.hhs.gov/medicarereform/medicarereformfaqs.asp click on “Prescription Drug Coverage” 1-800-MEDICARE scripts http://www.cms.hhs.gov/partnerships/news/mma/scripts.pdf State Captain for each Region

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