Ala. Admin. Code r. 560-X-25-.17
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-25-.17 - Low Income Subsidy (LIS)(1) The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), established the Medicare Prescription Drug Program, also known as Medicare Part D, making prescription drug coverage available to Medicare beneficiaries. The MMA also provides extra help in the form of a Low-Income Subsidy (LIS) to apply to the premium cost associated with Medicare Part D. Individuals qualifying for LIS will receive full or partial assistance with the monthly Medicare Part-D premium, the yearly deductible, and prescription co-payments depending on the income, family size, and resources of the beneficiary.(2) Medicare beneficiaries with full Medicaid, SSI recipients, and Medicare beneficiaries participating in the Medicare Savings Programs (QMB, SLMB, QI) will be deemed to be eligible for LIS, and do not have to make a separate application. Medicare beneficiaries with limited income and resources who do not fall into one of the deemed subsidy groups must make application for the LIS Program through the Social Security Administration or the Medicaid Agency. If an individual or couple completes the Social Security Administration's LIS application at a Medicaid site, or forwards a completed Social Security Administration LIS application to a Medicaid site, the Medicaid Agency will forward the completed application to the Social Security Administration's LIS processing center. If an applicant insists upon a formal LIS determination by Medicaid, the applicant must complete a Medicaid LIS application and submit the required verification to the Medicaid Agency.(3) Individuals must be entitled to Medicare Part A (Hospital Insurance) and/or Part B (Medicare Insurance) and enroll in a prescription drug plan that services their area. See 2006 Subsidy Eligible Groups at http://www.alabamaadministrativecode.state.al.us/docs/med/Microsoft%20Word%20-%2025MED.pdf
(4) The following eligibility criteria must be met:(a) Resource limits are effective using SSI criteria1. Individual at or below $10,000 plus $1,500 burial exclusion2 Couples at or below $20,000 plus $3,000 burial exclusion (b) Income limits are effective using SSI criteria 1. Full subsidy - income at or below 135% of the FPL2. Partial subsidy - income above 135% but below 150% of the FPL(c) Poverty level standards for income will be based on household size which will include the applicant, his/her spouse, and all relatives for whom the applicant provides support and could claim for income tax purposes, and who are living with the applicant.(d) Income and resources will be verified(5) LIS eligibility is as follows:(a) For calendar year 2006, eligibility is effective as of the first day of the month of application, but not earlier than January 1, 2006, and remains in effect for a period not to exceed one year.(b) For any calendar year after 2006, eligibility is effective as of the first day of the month of application and remains in effect for a period consistent with the State Plan, but not to exceed one year.(c) LIS determination is not a determination for eligibility for Medicaid services.(d) LIS is subject to Medicaid administrative rules and policies regarding application processing and redeterminations Author: Audrey Middleton, Associate Director, Policy and Program Implementation Unit, Certification Support Division
Ala. Admin. Code r. 560-X-25-.17
New Rule: Filed January 11, 2006; effective February 15, 2006.Statutory Authority: Social Security Act 1935(a), 1860D-14, 1905(p)(3); and 42 CFR 423.774 and 423.904.