1 Department of Medical Assistance Services Department of Medical Assistance Services – Eligibility and Enrollment Unit February 2013 *REVISED 1 Department of Medical Assistance Services MMIS: New Special Low-income Medicare Beneficiary (SLMB) Plus Enrollment

2 Department of Medical Assistance Services Agenda Overview New MMIS SLMB Plus Full-Medicaid Aid Categories (AC) SLMB Plus Enrollments- –New enrollments: MN only and 300% group Transition of current full coverage members to new SLMB Plus AC’s Contacts

3 Department of Medical Assistance Services SLMB Plus Overview At the federal level a SLMB Plus member is one who moves from SLMB to full-coverage. This term was not used previously in Virginia as designated AC’s were not available. Reduce expenditures for Part B premium costs for certain members whose premiums are eligible for federal matching funds Track the SLMB Plus population

4 Department of Medical Assistance Services SLMB Plus Overview SLMB Plus AC definition is a member enrolled in Medicare Part A, with income > 100% FPL and <= 120% FPL Members in these 4 new AC’s will be eligible for full coverage Medicaid and Part B premium payment.

5 Department of Medical Assistance Services Aid Categories Four new aid categories have been implemented for SLMB members who attain full coverage: –024 MN Aged SLMB Plus –044 MN Blind/Disabled SLMB Plus – % SSI aged SLMB Plus – % SSI blind/disabled SLMB Plus * Note: These are new MMIS enrollment aid categories; not new eligibility groups.

6 Department of Medical Assistance Services Transition to New AC’s A current SLMB member will only transition to one of the new AC’s by; –Meeting a spenddown; –Reporting a change; –Reporting a need for long term-care (LTC); or –at Renewal, if the member would be SLMB only were it not for receipt of Medicaid LTC coverage

7 Department of Medical Assistance Services Transition to New AC’s – Disabled Example A disabled member is found eligible for and enrolled in SLMB AC 053 effective 1/1/13. The member is placed on two six month spenddowns. The member then submits medical bills which meet the spenddown liability on 3/1/13. The member meets all other MN financial requirements. The member will now be enrolled in SLMB Plus AC 044 (MN Blind/Disabled) from 3/1-6/30/13.

8 Department of Medical Assistance Services Transition to New AC’s – LTC Example An aged member is found eligible for and enrolled in SLMB AC 053 effective 1/1/13. The member enters a nursing facility on 3/1/13. The member meets all LTC financial and nonfinancial requirements. The member will now be enrolled in SLMB Plus AC 025 (300% SSI Aged).

9 Department of Medical Assistance Services When to Transition to New ACs The transition to the new SLMB Plus AC’s will take at least 12 months for members who are currently enrolled in the 300% group. These members would be SLMB only if not for the receipt of Medicaid LTC. The transition should take place at renewal or a reported change. As SLMB’s meet a Spenddown the new MN SLMB Plus ACs will be used to enroll the member in their SD eligibility period. *The use of SLMB Plus AC’s is effective 2/10/13 9 Department of Medical Assistance Services

10 Department of Medical Assistance Services New SLMB Plus Enrollments-Applicants An applicant could be found eligible in a SLMB Plus AC if they would otherwise be eligible for SLMB Only limited coverage but for; –the need for long-term care has already been established or; –the applicant presents medical bills which meet their spenddown liability on the first day they would be eligible for coverage.

11 Department of Medical Assistance Services Member Meets Spenddown 11 Department of Medical Assistance Services

12 Department of Medical Assistance Services Member Meets Spenddown 12 Department of Medical Assistance Services

13 Department of Medical Assistance Services Summary 4 new AC’s for SLMB Plus full-Medicaid Transition to new AC’s will occur over the next 12 months based on; –Renewals –Reported changes –Member meeting spenddowns All current procedures for MMIS data entry still apply for the new aid categories; –MMIS Coverage Correction forms should still be submitted to the DMAS Eligibility and Enrollment Unit Inbox: Questions regarding this training can be directed to: 13 Department of Medical Assistance Services

14 Department of Medical Assistance Services Contacts Eligibility and Enrollment Unit: Enrollment Inbox: Lois BrengelSarah Samick (804) (804) Policy Unit: Kelly PauleyKaren Packer (804) (804) Cindy Olson (804) Department of Medical Assistance Services

15 Department of Medical Assistance Services Thank You! Send all questions and proposed topics for future trainings to the or you may contact Sarah Samick, Lead Enrollment Phone: (804) Fax: (804) Department of Medical Assistance Services