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Optional Exception for Dual-Eligible Individuals and Individuals who Qualify for the Low-Income Subsidy:

For enrollment requests submitted by dually eligible individuals and individuals who qualify for the low-income subsidy (LIS), an MAO may consider an enrollment request complete if there are premium amounts due to the organization from a prior enrollment, even if the MAO has a policy to consider such enrollment requests incomplete.

The MAO has the discretion to implement this exception to dually eligible individuals and individuals who qualify for LIS within each of its MA plans. If the MAO offers this exception in one of its plans, it must apply the policy to all such individuals who request enrollment in that MA plan.

• U.S. Citizenship or Lawful Presence Information – Plans must use the CMS Batch Eligibility Query (BEQ) (individual or batch submission) or, via online access, the MARx M232 screen to verify eligibility on the basis of incarceration status or unlawful presence status. An exception to this is an enrollment request from a current enrollee of a plan who is requesting enrollment into another plan offered by the same organization or sponsor with no break in coverage (i.e., “switching plans”).

Individuals are not required to provide evidence of U.S. citizenship or lawful presence status with the enrollment request, nor are plans permitted to request such information or documentation. The systems (BEQ or MARx online query) will indicate the lawful presence status of a non-U.S. citizen, including the start and, if applicable, the end date of the unlawful presence status of the individual.

CMS eligibility queries will only reflect data for the existence of an unlawful presence status. When neither the BEQ nor the MARx online query shows any indication of unlawful presence in the U.S., the plan must treat the lack of information as confirmation of evidence of U.S. citizenship or lawful presence status.

When either the BEQ or the MARx online query shows an indication of unlawful presence in the U.S. and the organization receives documentation of lawful presence from the applicant, the plan cannot use this documentation to establish eligibility. If the plan is provided evidence of lawful presence by the applicant in the form of a document from the Department of Homeland Security or SSA and neither the BEQ nor the MARx online query reflects this lawful presence status, the organization should refer the applicant to SSA to request that SSA update its records.

50.1 – Who May Complete an Enrollment or Disenrollment Request 42 CFR §§ 422.60, 423.30, 423.32, and 435.923

Generally, plans can accept enrollment requests from an eligible individual or the individual’s authorized representative (as recognized by State laws) for enrollment in or disenrollment from an MA or Part D plan. CMS will recognize State laws that authorize persons to make such