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38.7 Impact on Dual Eligible Individuals Individuals who are enrolled in Medicare (Part A and/or B) and are eligible for BadgerCare Plus under a Title 19 (Medicaid) funded Med Stat Code are referred to as Dual Eligible individuals. Since January 1, 2006, Medicaid does not provide prescription drug coverage for these individuals. Instead these individuals receive prescription drug coverage through Medicare Part D. These Dual Eligible individuals are deemed eligible for "Extra Help” from CMS to help pay for their Medicare Part D drug costs. A Medicare Part D Preferred Drug Plan (PDP) card will be issued to them, and it must be used for prescription drugs instead of their Forward Card. For more information on Medicare Part D, see the Medicare Drug Coverage (Part D) webpage. This page last updated in Release Number: 11-01 Release Date: 03/29/11 Effective Date: 03/29/11 38.8 Five Percent Cost Share Limit Members may not pay more than 5% of their household income for monthly premiums and copays for BadgerCare Plus or Medicaid card services. This limit does not apply to deductibles, patient liability for Institutional Medicaid, or cost sharing for Home and Community-Based Waiver services. The 5% cost share limit applies to members eligible for BadgerCare Plus, SSI Medicaid, and most EBD Medicaid programs. Members enrolled in MAPP and SeniorCare do not have a cost-sharing limit. For members subject to the cost-sharing limit, a copay limit will be set on a monthly basis. The copay limit is based on the assistance group’s income used to determine eligibility. Copays are tracked based on copays the individual has incurred, not the amount of copays actually paid. 38.8.1 Copay Limits for Members and Programs exempt from copays Members who are in a copay exempt category (see SECTION 38.2.2 COPAY EXEMPT POPULATIONS) will not have a copay limit while they are copay exempt since they have no copays. Members who are enrolled in any copay exempt subprograms (see SECTION 38.2.3 COPAY EXEMPT PROGRAMS) will have a copay limit of $0 as there are no copays for members enrolled in these programs. 38.8.2 Programs Excluded from the Five Percent Cost Share Limit Members enrolled in the following subprograms will continue to be charged premiums and copays with no 5% cost share limit set based on their income: • Medicaid Purchase Plan (MAPP) • SeniorCare Note Members who are enrolled only in Medicare Savings Programs (except for Qualified Medicare Beneficiaries (QMB)) do not receive Medicaid card services and thus do not have copays.