2. If a Medicare beneficiary qualifies for Medicaid but is not yet enrolled, what is the process for enrolling the individual in Medicaid as well as verifying that s/he is "deemed eligible" for the low-income subsidy?
A Medicare beneficiary who qualifies for Medicaid but is not yet enrolled into Medicaid should submit an application to the state Medicaid office.  In most states, this application must be done in-person; however some states have implemented an online Medicaid application. 

A beneficiary who is already in Medicare who then later qualifies for Medicaid may or may not have chosen and enrolled into a Part D plan.  In either case, both an application for Medicaid and an application of Extra Help (LIS) should be filed.  The low-income subsidy is retroactive to the first day of the month in which an eligible individual applies for extra help; Medicaid eligibility may, at state discretion, be retroactive to three months before the month of application.  After both Medicaid and LIS applications are filed, this beneficiary should review his or her plan options and enroll in a plan that best suits his or her drug needs.  An individual who qualifies for extra help and applies for the subsidy would be refunded any out-of-pocket costs s/he spends for a Part D plan (over the set LIS amounts) from the first day of the month of application for extra help.

This process is significant in that the deemed status of the beneficiary is not be available immediately after applying for Medicaid.  Once the state determines the Medicaid eligibility of the individual, this information will then be reported to CMS through the state's next monthly notification.  CMS would then deem the individual eligible for extra help in the following month and send a letter to the beneficiary with the auto-assigned plan and the effective date of enrollment (at least two months from the date that CMS deems eligibility).  If by that date, the beneficiary has not yet selected a Part D plan, s/he would then be randomly autoenrolled into a Part D plan.  Thus, if a beneficiary waits for the auto-enrollment process to enroll him or her into a plan, many months will have elapsed.  If the individual enrolls in a plan at the same time s/he applies for extra help and Medicaid, s/he may be charged some out-of-pocket costs for the plan, but these would be refunded. 

Reference Information

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