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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850

Center for Medicaid and State Operations

SMDL # 10-003

February 18, 2010

RE: Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

Dear State Medicaid Director:

This letter provides guidance on the implementation of certain provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), P.L. 110-275. Specifically, this letter provides information about the sections of MIPPA that relate to the Medicaid program. Many of these provisions are intended to remove barriers to applications for the Medicare Part D Low-Income Subsidy (LIS) and the Medicare Savings Programs (MSP). More detailed explanations of the provisions are provided in the enclosure to this letter.

Section 111 - Extension of the Qualifying Individual (QI) Program

The Qualifying Individuals (QI) program provides 100 percent Federal funding to States for the payment of Medicare Part B premiums, for individuals with income at least equal to 120 percent, but below 135 percent, of the Federal poverty level. Because QI beneficiaries are not eligible for other Medicaid program benefits, this federal payment of their Medicare Part B premium helps ensure that these individuals have access to the full array of Medicare benefits. Section 111 of MIPPA funded the QI program at $400 million for Federal fiscal year (FY) 2008, $450 million for FY 2009, and $150 million for the first quarter of FY 2010. Subsequent legislation, including the QI Supplemental Funding Act of 2008 (P.L. 110-379), the American Recovery and Reinvestment Act of 2009 (P.L. 111-5), and the Emergency Aid to American Survivors of the Haiti Earthquake Act of 2010 (P.L. 111-127) provided additional funding for and further extended the QI program. The total funding available for the QI program was $415 million for FY 2008 and $480 million for FY 2009. The current funding for the QI program for FY 2010 totals $612.5 million and $165 million is currently available for the first quarter of FY 2011.

Section 112 - Application of LIS Resources Tests to MSP

Section 112 of MIPPA amended section 1905(p)(1)(C) of the Act to make the resource limit for Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB) and QIs conform to the resource limit for individuals who qualify for the full subsidy Medicare Part D LIS. This change in the resource limit does not apply to all MSPs. The resource limit for Qualified Disabled Working Individuals (QDWI), set forth in 1905(s) of the Act, was not changed by MIPPA.