Family & Children's Medicaid Change Notices
CHANGE NOTICE FOR MANUAL NO. 02-07 MEDICARE ENROLLMENT AND BUY IN
DATE: NOVEMBER 29, 2006
Manual: Family And Children’s Medicaid
Change No: 02-07
To: County Directors of Social Services
Effective: January 1, 2007
MA-3525, Medicare Enrollment And Buy-In, has been updated effective January 1, 2007, to include that EIS now generates letters to Medicaid recipients age 65 or older or within three months of turning 65 without an RSDI claim number. These people are eligible for Medicare Part B buy in. Recipients with Medicaid classifications F, H, O, and R do not receive the notices. The notice continues to be sent to Medicaid recipients until the RSDI claim number is entered into the system. A copy of the notice, MA-3525/MA-3525S, Figure 9, is attached.
A. Medicare Enrollment Automated Notice
1. The automated notice advises the recipient of the following information:
a To contact the Social Security Administration for an appointment to apply for Medicare Part B.
b. Medicaid pays the monthly Medicare Part B premiums.
c. Medicaid pays Medicare Part A and Part B sharing amounts (up to the Medicaid allowable rate) for doctor and hospital care.
d. If the recipient fails to enroll in Medicare Part B, Medicaid does not pay for medical bills incurred that Medicare would have paid.
2. The return address on the automated recipient notice is the county dss address.
3. NCXPTR displays two reports containing the name of each Medicaid recipient that receives the notice. The reports run monthly. Each report is sorted by county and alphabetically by recipient name.
a. The report titles are DHRWDB AGE 65 NOTICE REGISTER and DHRWDB OVER 65 WITH NO RSDI #. Caseworkers must review the reports to ensure those recipients received the letter. If the notice is returned, determine the correct address and forward the letter to the correct address.
b. Caseworkers must review the report to ensure those recipients received the letter. If the notice is returned forward it to the correct address.
c. Caseworkers must review the DHRWDB OVER 65 report and verify monthly with SOLQ if the recipient is enrolled in Medicare. Caseworkers must not enter Medicare in EIS if the Medicare effective date is in the future as this adversely affects Part D information. Once Medicare enrollment is verified, the IMC must enter Medicare A or B and the RSDI claim number into EIS.
B. Additional Changes
1. Clarification has been included regarding approval of ongoing medically needy open/shut applications or cases with retroactive periods. The clarification is as follows:
a. If ongoing eligibility is approved as a medically needy (“M”) case while the retroactive period pends the IMC must complete and mail a DMA-5004, Buy-In Clerical Action, (See figure 8) to the Medicaid claims processing contractor when the retroactive part is approved, indicating the correct effective date of buy-in.
b. If the classification is "M" and the case is an open/shut application with only two months of authorization, buy-in is not applicable. Do not send a DMA-5004, Buy-In Clerical Action.
2. MA-3525 has also been expanded to include Medicare Part C and D definitions.
II. EFFECTIVE DATE AND IMPLEMENTATION
This change is effective January 1, 2007. However, continue to notify applicants and recipients during the application and redetermination process regarding the requirement to enroll in Medicare Part B.
III. MAINTENANCE OF MANUAL
A. Remove MA-3525, Medicare Enrollment And Buy-In, pages 1-19.
If you have any questions, please contact your Medicaid Program Representative.
L. Allen Dobson, Jr., M.D., Assistant Secretary
for Health Policy and Medical Assistance
(This material was researched and written by Sandi Morrow, Medicaid Policy Consultant, Medicaid Eligibility Unit)