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Page 2 - State Medicaid Director

Effective January 1, 2010, the resource limits for the QMB, SLMB and QI programs are $6,600 for a single person and $9,910 for a married person living with a spouse and no other dependents. These resource limits are adjusted on January 1 of each year, based upon the change in the annual consumer price index (CPI) since September of the previous year. States must use the new resource limits when determining eligibility for these programs.

Section 113 - Eliminating Barriers to Enrollment

Under section 113 of MIPPA, the Social Security Administration (SSA) is directed to transmit data from the LIS application, with the consent of the applicant, to the Medicaid agency for purposes of initiating an application for MSPs. Starting January 1, 2010, the State is directed to treat the data as an application for MSP benefits, as if it had been submitted directly by the applicant.

Since 2005, CMS has been transmitting LIS data from SSA to States as “leads data.” However, prior to the enactment of MIPPA, States had the option to process or follow-up on the data transmitted. Starting January 1, 2010, States must act on the data as an application for MSP benefits, even if the LIS application was denied by SSA. States continue to have the option and are encouraged to conduct a full Medicaid eligibility determination for these individuals.

MIPPA also required CMS to make available to SSA and the States MSP model applications that can be provided to beneficiaries upon their request. SSA will provide the CMS-designed and translated model MSP application in 11 languages (see discussion of MIPPA section 118 below). If a State receives a model MSP application in any language, it must be treated as an application for MSP, even if it does not ordinarily use the model MSP application.

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

Effective January 1, 2010, section 115 of MIPPA requires States to exempt Medicare cost- sharing benefits paid under the MSPs from estate recovery under section 1917(b)(1) of the Act. The intent of this provision is to encourage dual eligible beneficiaries to more fully utilize Medicare cost-sharing benefits available through the MSPs and allay concerns that Medicaid estate recovery will, after their death, lay claim to recover the value of these cost-sharing benefits from their estate.

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

Under section 116 of MIPPA, SSA is directed not to count in-kind support and maintenance as income, and not to count the cash surrender value of life insurance policies as a resource, when determining eligibility for LIS. These disregards apply only to LIS eligibility determinations. They do not extend to eligibility determinations for MSP, or for Medicaid in general. Although this provision is not a Medicaid provision, it is included in this guidance to emphasize the differing eligibility factors between MSP and LIS eligibility.