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Example 2 In August, Charlie lost his job at the Burger Palace. In September, Charlie applied for SeniorCare. In his application, Charlie erroneously reported income of $1150 per month from the Burger Palace job. Charlie’s notice of decision had a mail date of October 1, and stated that Charlie had a $1500 spenddown. Depending on when Charlie reports this error, his benefits may be corrected back to the eligibility begin date or the first of the month in which the error was reported (see SECTION 33.10.2 CORRECTION OF ERRORS). If he reported the error by November 15, within the first 45 days after the notice of decision mail date, his benefits would be corrected back to the original effective date. If he reported the error November 16 or later (more than 45 days after the notice of decision mail date), the benefit level change would be made effective the first of the month in which the error was reported.

Example 3 Eric applied for SeniorCare in July and was determined eligible at level 1 effective August 1. Prior to applying for SeniorCare, Eric got a part-time job that had begun in June. When Eric applied for SeniorCare, he neglected to report his anticipated part-time earnings on the SeniorCare application. Eric receives his notice of decision, dated August 8. The notice informs him that he is eligible at level 1. Eric reviews the income used in his eligibility determination that is printed in the notice and realizes that he forgot to report the earnings from his part-time job. He calls the SeniorCare Customer Service hotline on August 21 to report his error. The earnings from Eric's part-time job move him from level 1 to level 2b. Since the income correction will result in a negative impact on his eligibility, the effective date of the corrective benefit is October 1, providing Eric with a 10-day notice of the negative action in his case. Prior to reporting this mistake, Eric had purchased several prescriptions at the copayment levels with his SeniorCare card. These overpaid benefits will not be recovered. Since the correction resulted in Eric’s eligibility at level 2b, he must now meet an $850 deductible between October 1 and July 31 (the end of his 12-month benefit period). 33.10.3 Fraud Fraud is defined as intentionally getting or helping another person get benefits to which they are not entitled. Penalties for fraud include a fine of up to $10,000, imprisonment up to one year, or both, and suspension from the SeniorCare program. Fraudulent acts include: 1. Intent to provide misleading, fraudulent, omitted, or incomplete information on the SeniorCare application; 2. Not reporting an event that knowingly affects initial or continued eligibility for SeniorCare; 3. Applying for SeniorCare on behalf of another person and use of any part of the benefit for oneself; 4. Allowing another person to use someone else’s card to get prescription drugs. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026 33.11 SeniorCare Re-Application SeniorCare members may request to establish a new SeniorCare benefit period at any time. However, it is not beneficial for a SeniorCare member to reapply unless they will experience a reduction in gross