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Beneficiary Impact: Transmission of the LIS application data to the State Medicaid agency is anticipated to simplify the enrollment process in MSP for LIS beneficiaries. The LIS beneficiaries will not have to go into the Medicaid office in order to apply for MSPs. Additionally, more beneficiaries will become aware of MSPs when contacted by the State Medicaid agency.

State Action: States needed to update the State data exchange agreements with SSA to encompass the exchange of the new data. States were required to complete new agreements by the close of calendar year 2009.

Section 115: Eliminating Application of Estate Recovery to Medicare Cost- Sharing Benefits

Effective January 1, 2010, section 115 of MIPPA required States to exempt Medicare cost- sharing benefits (i.e., Part A and Part B premiums, deductibles, coinsurance, and co-payments) paid under the MSPs from estate recovery under section 1917(b)(1) of the Act. The exemption applies to the following groups of dual eligibles: QMB, SLMB, QI, QDWI, QMB Plus (QMB with full Medicaid benefits), and SLMB Plus (SLMB with full Medicaid benefits).

Two factors govern exclusion of MSP cost-sharing benefits in the Medicaid claim against the estate of a deceased recipient:

Date of service: Exemption of MSP cost-sharing benefits from estate recovery extends only to benefits with dates of service on or after January 1, 2010. States that have elected in their State plan to include MSP cost-sharing benefits as Medicaid expenditures for which estate recovery is sought should continue to perform estate recovery for these benefits against the estate of a dual eligible whose date of death is on or after January 1, 2010, with dates of service for those beneficiary’s claims before January 1, 2010.

The date of service for MSP deductibles, coinsurance, and co-payments is the date the request for payment is received by the State Medicaid agency. For premium payments, the date of service is the date the State Medicaid agency paid the premium.

Date of death: This new MIPPA exclusion does not apply to estate recovery for deaths that occur before January 1, 2010.

Also, this MIPPA exclusion does not affect inclusion of MSP cost-sharing benefits received before January 1, 2010 in the Medicaid costs that are included in a lien that was in effect at the time of the recipient’s death, regardless of the date the lien was initiated or the date of the recipient's death.

MIPPA does not exempt MSP-eligible individuals from all estate recovery. The service which is exempted from estate recovery is the MSP cost-sharing benefit, as detailed above. Benefits not related to MSP cost-sharing are still subject to estate recovery for MSP.