Beginning in April 2023 and persevering with by December 2025, older adults who’re dually eligible for Medicare and Medicaid will face redeterminations of their Medicaid eligibility, a course of that was suspended through the COVID-19 Public Well being Emergency (PHE). Throughout this “Medicaid unwinding” interval, advocates working with folks dually enrolled in Medicare and Medicaid ought to find out about two necessary options of the Medicare Half D Low Earnings Subsidy (“LIS” or “Additional Assist”): (1) Medicaid termination doesn’t instantly finish LIS enrollment; and (2) LIS eligibility is extra beneficiant than Medicaid and Medicare Financial savings Program (MSP) eligibility guidelines in most states.
LIS is a program administered by the Social Safety Administration (SSA) that subsidizes the premiums and price sharing of Half D prescription insurance coverage for low-income enrollees. Medicare enrollees who’re additionally enrolled in Medicaid, together with a Medicare Financial savings Program, are robotically enrolled in LIS, which suggests they’re eligible for a zero-premium, zero-deductible Half D plan with the bottom, mounted copays. Medicare enrollees who should not dually enrolled in Medicaid or receiving Supplemental Safety Earnings (SSI) may qualify for the LIS if their revenue is beneath 150% of the Federal Poverty Degree (FPL)–$22,590 in 2024–and their property are beneath the restrict.
LIS has its personal eligibility guidelines and protections aside from Medicaid. One necessary safety that may be particularly useful for folks dropping Medicaid eligibility through the unwinding is that LIS eligibility typically extends past the Medicaid termination date. Because of this even when a Medicare enrollee loses their Medicaid eligibility, they are going to proceed to get assist with their prescription drug prices for the rest of 2023, and in lots of circumstances 2024.
Justice in Getting older is sharing these apply suggestions to assist advocates make sure that older adults perceive their LIS enrollment throughout Medicaid unwinding and their choices for persevering with their LIS protection.
LIS Enrollment Does Not Routinely Terminate on the Identical Time As Medicaid
- If somebody loses all Medicaid (together with MSP) earlier than July 1, they nonetheless hold their LIS till the tip of the calendar 12 months. For the next 12 months, they need to apply for LIS and SSA will redetermine their eligibility primarily based on their revenue and property. Medicare sends a discover (on grey paper) concerning LIS eligibility in September, together with an LIS software that have to be submitted to SSA to reenroll in LIS. The enrollee could obtain extra correspondence from SSA asking for extra data.
- Instance: Sally obtained a discover from her state Medicaid company informing her that as a result of her revenue elevated through the PHE, her Medicaid eligibility will finish on June 30, 2023. Sally’s LIS enrollment will proceed by December 31, 2023. Round September 2023, Sally ought to look ahead to—and reply to—a letter from Medicare notifying her of disenrollment from LIS and asking her to re-apply. She may additionally obtain correspondence from SSA and her Half D plan concerning LIS.
- If somebody loses all Medicaid (together with any MSP) after July 1, they are going to hold their LIS all over the tip of the next calendar 12 months. SSA is not going to redetermine their LIS eligibility till the following 12 months.
- Instance: John finds out that his Medicaid protection will terminate on August 31, 2023. His LIS enrollment will proceed till December 31, 2024 and SSA will reassess his eligibility in 2024. John ought to be looking out for correspondence concerning his 2025 LIS eligibility from Medicare in September 2024.
- If somebody loses Medicaid for procedural causes (e.g., by not responding in time to the state’s discover of redetermination) however subsequently recertifies or re-applies and is re-enrolled in Medicaid, LIS will robotically proceed with out interruption.
NOTE: If a person loses eligibility for full-scope Medicaid however remains to be is eligible for a Medicare Financial savings Program, they are going to hold LIS with no need to take any motion. Throughout a Medicaid redetermination, states are required to contemplate eligibility for all Medicaid applications, together with all MSPs.
LIS eligibility is extra beneficiant than Medicaid and Medicare Financial savings Program eligibility guidelines in most states.
Medicare enrollees who’re not eligible for any Medicaid applications could independently qualify for LIS, since LIS has separate revenue and asset limits which are increased than these of most Medicaid and MSP applications. They need to promptly return the Additional Assist software they obtain with their discover of LIS termination or apply on-line. It’s necessary to apply for LIS earlier than the tip of the 12 months to make sure no gaps in prescription drug help.
Some Folks Who Lose Medicaid Eligibility Will Want To Change How They Get Their Medicare Prescription Drug Protection
If somebody is disenrolled from a dual-eligible particular wants plan (D-SNP) or different Medicare-Medicaid plan and loses the corresponding Half D protection by the plan, they’ve a Particular Enrollment Interval that enables them to enroll in a brand new plan. They’ll use the LI-NET program to entry their LIS advantages till they re-enroll. If they don’t affirmatively select a plan, CMS will auto-enroll them is a benchmark Prescription Drug Plan (PDP).
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