Medicare Prescription Drug Plan Low Income Subsidy The Application Process Roy Trudel, CMSO National Eligibility Workers Call November 23, 2004

Low Income Subsidy Application Process About 11 million potential LIS benes --- Goals --- Avoid confusion for beneficiaries Process initial 11 M applications Foster national consistency Take burden from States

Where will beneficiaries apply?  At SSA -Field offices -Mail in -On the internet -Over the telephone …and

Where will beneficiaries apply?  At other outreach locations such as:  Senior centers  Offices on Aging  Health care provider sites  Others….. Note – “outreach” application sites will use the SSA Application/Determination process …and

Where will beneficiaries apply?  At State Medicaid Agencies  Using the SSA application/process  Using a State’s own application/process

Low Income Subsidy Application Process Does it matter who determines eligibility? Yes! and No! Note – this is different from who “takes the application”

Low Income Subsidy Application Process SSA... using nationally consistent LIS eligibility standards based on SSI concepts. State Medicaid Agencies... Who makes the eligibility determination?

Low Income Subsidy Application Process Whoever makes the initial determination... Conducts the periodic redetermination Conducts eligibility appeals

Low Income Subsidy Application Process SSA... Using a national SSA process as determined by the SSA Commissioner State Medicaid Agencies... Using that State’s Medicaid redetermination and appeals process Periodic redeterminations or eligibility appeals

Timeline SSA will be ready to process LIS applications in July 2005 Ambitious Goal: –50% of LIS-eligible beneficiaries by September 30, 2005 –90% of LIS-eligible beneficiaries by November 30, 2005

SSA’s Application Development: The LIS application is key to program success Focus group and cognitive tested Many iterations Now in final clearances

SSA’s Application Has a cover letter Large type White space Embedded examples - “how to” fill out Qs/As Spanish version Fact sheets in 14 languages SSA field offices have bilingual staffs

SSA’s Application SSA’s process is automated. Application optically scannable Beneficiary attests to information Data matches for verification Some questions “kick out” and SSA contacts the individual for details.

SSA’s Application Based on a hierarchical process Based on SSI income & resources concepts Applicants and spouses use same form; i.e.; apply together

SSA’s Application Starts with a screen-out question If deemed eligible, don’t file an application Automatically enrolled for the subsidy

SSA’s Application Resources Broad resources screen-out question Resources over $11,500 (single) or $23,000 (married)? Yes – Don’t complete application; not eligible No or not sure – keep going

SSA’s Application Resources cont’d Value of – Bank accounts Stocks, bonds, mutual funds, etc. Cash on hand

SSA’s Application Resources cont’d Life insurance policies – face value $1,500 or more? Money set aside for burial? Non-home real estate?

SSA’s Application Family Size Income standard based on family size Only applicant’s & spouse’s income counted Family – Relatives living with applicant who get at least one-half support from applicant Relative – Blood, marriage, or adoption

SSA’s Application Income Unearned income –Social Security –Railroad Retirement –Veterans –Other stuff –In-kind support & maintenance

SSA’s Application Income cont’d Earned Income –Wages, salary –Self-employment Impairment-related work expenses (IRWEs)

SSA’s Application SSA is developing a quality assurance process Look at the effectiveness of the process Inform future eligibility operational policy decisions

SSA’s Application Taking the Burden from States SSA willing and able to process applications taken by states Entirely voluntary for states States would use SSA’s application form States could submit applications to SSA’s data processing center in Wilkes-Barre, PA, or via Internet

SSA’s Application CMS encourages states to use the SSA process States would function as intake source SSA would own the redeterminations and appeals for applications it processes The big question – Would this fulfill the law’s requirement that states make eligibility determinations?

SSA’s Application Lastly – (and importantly!) SSA is only involved in LIS eligibility. SSA is NOT involved in enrolling beneficiaries into a Medicare Prescription Drug Plan.

SSA’s Outreach Massive Outreach plans –Letters/notices –Grass roots –Media The “deemed” eligible will get “good news” letters instead of outreach to apply.

SSA’s Outreach Messages: You may be eligible Apply w/SSA Apply early Apply via form, internet, phone, walk in Select a drug plan

SSA’s Training Planning for extensive training for –State eligibility workers –Community Based Organizations –SHIPs Writing guides for “non-intake” types to be able to assist beneficiaries filling out application.

Timeline - What, me worry? 10/4/04 – Comments due on CMS NPRM Early 2005 – Publish final CMS rule 3/1/05 – MPDP applications due to CMS May/June 2005 – SSA begins LIS Outreach 6/1/05 – CMS approves applications 6/6/05 – MPDP bids due 6/30/05 – SSA goal: process 50% apps.from LIS benes 9/5/05 – CMS awards MPDP bids October 2005 – CMS writes to beneficiaries to enroll 11/15/05 – Initial open season enrollment begins 11/30/05 – SSA goal: process 90% apps. from 90% LIS benes 1/1/06 – Dual eligibles lose Medicaid drug coverage