MEMORANDUM

DATE:          September 1, 2005

TO:               All Aged, Disabled and Long Term Care Medicaid Manual Holders

FROM:         Policy and Program Development Team

                      Ellie Fitzjarrald, Chief

SUBJECT: Aged, Disabled and Long Term Care Medicaid Manual Change #2

This manual change includes information about the new Medicare Part D prescription drug coverage. It incorporates policy revisions implemented by broadcast announcements, and makes minor technical changes. An index isIndividualized Supports added as a result of  suggestions received from field staff.

This manual change does not include policy regarding the Medicare low-income subsidy program, and processing the Medicare "extra help" applications. This policy and the EISEligibility Information System changes supporting it is under development and will be addressed in the next manual change. In the interim, please refer to the broadcast issued June 9, 2005, regarding guidelines for handling Medicare low-income subsidy applications received in DPADivision of Public Assistance offices.

Highlights of these policy additions and other clarifications are described below.

If you have any questions, please contact any member the Policy and Program Development Team at 465-3347 or email us at dpapolicy@health.state.ak.us.

OVERVIEW OF CHANGES

MS 506(D)(4) - Medicare Part D - Prescription Drug Coverage

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA ), adds Part D to Medicare, which makes prescription drug coverage available to all Medicare beneficiaries. Prescription drug plans will be available to help people with Medicare save money on prescription drugs. These prescription drug plans will become known in October 2005.  

Starting January 1, 2006, Medicaid will no longer pay for prescription drugs for people who are eligible for Medicare. People with both Medicaid and Medicare, known as "dual eligibles" will automatically be enrolled in a prescription drug plan to ensure there will be no break in coverage.  

Medicaid recipients who reside in nursing home or medical institutions who are eligible for Part D Medicare will have no deductible, premiums, and co-payments. All other Medicaid recipients and individuals in buy-in programs will continue to have co-payments.

In November, Centers for Medicare and Medicaid Services will send letters to all recipients with information about their prescription drug plan.  Medicaid recipients may choose to opt-out of a prescription drug plan, or enroll in another plan at any time as long as they are eligible for Medicaid. However, if a person chooses to opt-out of a prescription drug plan without enrolling in another plan, Medicaid will not pay for the cost for their prescription drugs.  In November, DPADivision of Public Assistance will be sending letters to Medicaid dual eligible recipients explaining this change in Medicaid coverage.   

As a reminder, when case reviews, new applications or redeterminations are made, staff need to check EISEligibility Information System coding to ensure proper entry of Medicare enrollment on the MEREMedical Reference screen.

MS 524 (F) - Institutional Allotment of Resources

Adds Medicaid exception to APAAdult Public Assistance resource policy for financial responsibility of spouses who no longer live together. This policy does not apply to institutional or waiver applicants.

MS 526 (D) - Payments Made from a QITQualifying Income Trust

Federal SSISupplemental Security Income regulations were amended effective March 9, 2005 to change the definition of income. Previous policy defined income as money that could be used to meet a person’s needs for food, clothing, or shelter. This change removes the term "clothing" from the definition of income. This change was previously issued by broadcast as a pen and ink change on April 19, 2005.

MS 554 - Transfer of Assets

Clarifies the transfer of asset penalty policy when both spouses’ are institutionalized.  

MS 561-G - EISEligibility Information System HCBHome and Community-Based Waiver Codes

Includes the "PM" subtype for use with home and community-based waiver services.

MS 570 - Post Eligibility and Cost-of-Care

Updates the personal needs allowance (PNA ) to $1396 as changed by Senate Bill 125 for Medicaid recipients who reside in assisted living homes.  Also includes clarification that unpaid medical bills that are not subject to payment by a third party are an allowable cost-of-care deduction.

Addendum 1 - Program Standards

Updates the PNAPersonal Needs Allowance to $1396 for individuals who reside in assisted living homes.  

Addendum 4 - COCACost of Care Processing

Updates the EISEligibility Information System cost-of-care (COCACost of Care) screen with the PNAPersonal Needs Allowance $1396 for individuals who reside in assisted living homes.

MANUAL CHANGE FILING INSTRUCTIONS