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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |123 Effective Month: September 2018 102.13.05 DUAL ELIGIBILITY, THE LOW-INCOME SUBSIDY (LIS) AND MEDICARE PART D PHARMACY PLANS Low-Income Subsidy (LIS) applications referred to DOM by the Social Security Administration (SSA) are discussed in Chapter 101. Specifically, 101.05.04 addresses the receipt and processing of LIS applications. LIS applications are primarily reviewed for eligibility in QMB, SLMB or QI categories, but an individual qualifying for the LIS may also be eligible in a full-service COE at the time the LIS application is filed or at a later date. An individual eligible for Medicaid and Medicare is automatically eligible for Medicare cost-sharing benefits as described above in 102.13.02, Medicaid Payment of Medicare Part A and Part B Cost-sharing Expenses. An individual eligible for Medicaid and Medicare, whether as a full dual or partial dual, is also eligible for cost-sharing benefits under Medicare Part D as described below. Medicare Part D is the pharmacy benefit under Medicare. The LIS program is an assistance program that all states finance in order to pay for the Medicare Part D program that is designed for low-income Medicare beneficiaries. The LIS pays Medicare Part D premiums, deductibles, co-insurance and co-pay charges to the Part D insurer participating in the LIS program. Information that must be explained to a Medicaid/Medicare applicant or recipient regarding pharmacy benefits is as follows: 1. There is no pharmacy benefit under Medicaid for Medicaid recipients with Medicare. The only exception to this rule is for certain classes of drugs that • the exact name as it appears on the Medicare card of an applicant/recipient, • the HIC# as it appears on the Medicare card of an applicant/recipient, • the correct DOB as verified by SVES, and • the correct gender for the individual. If special attention to these details is followed, records of all 3 agencies should match and buy-in should not be prolonged beyond the usual 3-month period.