Adult Medicaid Manual MA-2310 TAKING THE LIS APPLICATION

III. Policy principles

A. The DSS must offer to take an LIS application for any individual who appears at DSS requesting medical or financial assistance or requesting to apply for the LIS.

B. An application for the LIS is only required for Medicare beneficiaries who are not Medicaid recipients. Medicaid includes any aid/program category except MWD or NCHC.

An authorized Medicaid recipient in any aid/program category is automatically eligible for the LIS. However, if an individual is applying for Medicaid and is also a Medicare beneficiary, you must complete the LIS application and forward to SSA.

C. An individual must be entitled to Medicare Part A and/or enrolled in Part B to be eligible for the LIS.

1. The individual must be entitled to Medicare Part A and/or enrolled in Part B. This means the applicant should have a Medicare card. An individual who is ineligible for free Part A and who has not yet enrolled in Part B is ineligible for the LIS.

2. Verify Medicare enrollment by viewing the Medicare card or through SOLQ or BENDEX.

D. An individual must have income less than 150% of the federal poverty level for the family size.

E. An individual must have resources equal to or less than $11,570 for a single person or $23,120 for a couple.

F. An individual need not be a resident of North Carolina for you to take an LIS application and forward it to SSA.

If the individual insists on a state determination of eligibility for the LIS, he must apply with the Medicaid office in his state of residence.

If the individual insists on a state determination of eligibility for the LIS, he must apply with the Medicaid office in his state of residence.

G. An individual must provide his Social Security number.

REISSUED 01/01/12 – CHANGE 02-12

(III.)

H. The caseworker must evaluate a subsidy applicant for all Medicaid programs, including MQB-Q/B/E.

Follow intake procedures in MA-2300, Initial Contact, and MA-2301, Conducting A Face-to-Face Intake Interview, for an individual who comes to DSS to apply for the LIS or expressing any medical or financial need.

1. DO NOT refer the individual to SSA to complete the LIS application.

An individual who comes to the agency requesting to apply for the LIS must be treated the same as any individual requesting medical or financial assistance.

2. DO NOT post signs referring an individual to SSA for the LIS application.

3. Complete the DMA-5093, Daily Reception Log for Medical and Financial Assistance.

4. Explain to the individual his right to apply for assistance and have him sign the DMA-5094 or DMA-5094S, Notice of Your Right to Apply for Benefits.

5. Evaluate for all Medicaid programs:

a. If the individual chooses to apply for Medicaid, complete the appropriate forms and follow application processing requirements in MA-2301, Conducting a Face-to-Face Interview, MA-2303, Verification Requirements for Applications, and MA-2304, Processing the Application.

Complete the LIS application if the individual is a Medicare beneficiary and forward to SSA for processing. SSA may determine the individual eligible for the LIS before the Medicaid application can be processed.

b. If the individual chooses not to apply for Medicaid, treat as an inquiry and complete the DMA-5095, Medicaid/Work First Notice of Inquiry.

Complete the LIS application if the individual is a Medicare beneficiary and forward to SSA for processing.

c. Refer to VI. below for forwarding the LIS application to SSA for processing.

ISSUED 07/01/05 – CHANGE 21-05

(III.)

I. The agency must provide information about eligibility for the LIS to anyone requesting it or to a Medicare beneficiary who appears at DSS requesting financial or medical assistance.

The information may be requested by telephone or in person. Information given should include:

1. The income and resource limits;

2. Enrollment in Medicare Part A or Part B; and

3. Applicant may apply at SSA, dss or on-line at www.socialsecurity.gov. Explain that if the individual applies at DSS, Medicaid eligibility will also be evaluated.

4. Refer the individual to 1-800-MEDICARE (1-800-633-4227) or SHIIP at 1-800-443-9354 if the individual has questions about PDP enrollment.

J. The caseworker makes an eligibility determination for the LIS only if the applicant insists on a state determination.

DSS processing of the LIS application is not an option that is offered to the applicant. He must request that the agency process the LIS application.

It is to the client’s advantage to have DSS take the application but for SSA to process the application because:

1. SSA should process the application within 2 – 3 weeks and the agency has up to 45 days to determine eligibility.

2. SSA has automated matches with other federal agencies and does not require other verification from the beneficiary unless there is a discrepancy. The client must provide verifications to the caseworker according to Medicaid rules and procedures if DSS determines eligibility for the LIS.

3. Once SSA approves the LIS, the beneficiary’s information is transmitted electronically to a data base. This is a manual process for DSS and may cause a delay in receipt of the benefit. The agency has up to 45 days to process, and then sends the information to DMA where it must be manually added to a data file.

ISSUED 07/01/05 – CHANGE NO. 21-05

(III.J.)

4. If the Medicare beneficiary moves out of state and DSS processed the LIS application, the beneficiary will be terminated and must apply in the new state of residence. If SSA is responsible for processing the LIS application, the beneficiary does not have to reapply if he moves to another state.

K. If DSS determines eligibility for the LIS, the applicant must be provided a notice of his eligibility determination and granted an opportunity for appeal through the Medicaid hearing process. This is not the case if the LIS application is forwarded to SSA for processing.

L. When DSS determines eligibility for the LIS, the county is responsible for all redeterminations unless the individual subsequently becomes eligible for a Medicaid program. The individual is then a deemed eligible.