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Page 11 – State Medicaid Director

Beneficiary Impact: This legislation should encourage dual eligible beneficiaries to more fully utilize Medicare cost sharing benefits. It allays the concern that Medicaid estate recovery would, after their death, lay claim and be first to recover the value of these cost sharing benefits from their estates.

State Action: States will need to modify section 4.17 of their State Medicaid plans to reflect the changes brought about by section 115 of MIPPA.

Section 116: Exemptions from Income and Resources for Determining Eligibility for LIS

Section 116 of MIPPA is not a Medicaid provision, but it may prompt States to revise their MSP policies to align with new LIS provisions.

Section 116 of MIPPA amended section 1860D-14(a)(3) of the Act to exclude in-kind support and maintenance as income and the value of life insurance policies as a resource when determining LIS eligibility only. These disregards apply only to LIS eligibility determinations. They do not extend to eligibility determinations for MSP, or for Medicaid in general, unless a State decides to apply these changes to MSP.

States have the ability to disregard these items when determining eligibility for MSPs. To exercise this option, a State would need to submit a State plan amendment to disregard this income and/or resource, using section 1902(r)(2) authority. Such a change would simplify eligibility for States and MSP applicants.

Beneficiary Impact: This change will extend the LIS to more people and if States align their Medicaid rules, it would also extend MSP to more individuals.

State Action: No action is required by the States to implement this LIS provision. However, States will need to submit a State plan amendment, if they intend to utilize these disregards when determining MSP eligibility.

Section 118: Model Application

The Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), P.L. 106-554, amended section 1905(p)(5) of the Act to direct CMS to develop a simplified model application for the States to use, at their option, for application for MSPs. This model application is available on the CMS Web site at: (http://www.cms.hhs.gov/DualEligible/03_ ModelApplicationforMedicareSavingsPrograms.asp#TopOfPage).

Section 118 of MIPPA further amended section 1905(p)(5)(A) of the Act to require CMS to translate the MSP model application form into at least the 10 languages, other than English, that are most often used by those applying for Medicare. The new model application is now available (at the link listed above) in Arabic, Chinese, Creole, Farsi, French, Korean, Russian, Spanish, Tagalog, and Vietnamese for State use; however, use of the model application remains an option for the States.