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Processing LIS & MSP Applications

Tools #

LIS & MSP Application Flowchart

 

Guidance #

 

Staff will run Accuity on LIS/MSP Applications if the applicant has no active Non-MAGI coverage. An IM-1ABDS is not required if an IM1-MSP is received and should not be mailed to the participant. 

 

LIS (Low-Income Subsidy) example

LIS Application provides participants extra help with monthly premiums, annual deductibles and co-payments related to the Medicare Prescription Drug program. The application comes as a referral from the Social Security Administration, usually this is done when a participant has applied to receive help with their Part D through Social Security.

 

MSP (Medicare Savings Program) example

IM-1MSP Application helps Medicare (Part A and Part B) participants pay their medical premiums, Medicare deductibles and co-insurance copays, and costs that are not covered by Medicare.

 

When staff receive a task about a LIS/MSP application, they will explore the applicant’s eligibility for QMB/SLMB. Note: For SLMB1/SLMB2, prior quarter MUST be explored.

 

Check MEDES and FAMIS to determine if the applicant has active or pending MAGI or Non-MAGI, then use the appropriate below instructions to register/process the application.

 

No Active or Pending MAGI or Non-MAGI #

When the applicant has no active or pending MAGI or Non-MAGI follow the below instructions to register and process the Non-MAGI application using the information from the LIS/MSP applications and MEDES:

Reminder:

    • A new IM-1SSL is not necessary.
    • An IM-1ABDS is not necessary if an IM-1MSP was received. Use the application date for the date the IM-1ABDS was received.
    • If the applicant has an LIS application and has not submitted an IM-1ABDS, staff will call and obtain the information needed. Request for Non-MAGI benefits can be discussed with the applicant at this time.  If caller does not answer, staff will send an FA-325 requesting only information that would be relevant to the eligibility of the LIS application.
        • If pending for a source that does not have a proper title (i.e. checking account, but name of the bank is unknown) label as ‘unknown’ in the system.

 

    1. Registering ONLY an the LIS or MSP application in FAMIS.
        1. LIS application: Register with the Application Date as the request date
        2. MSP application: Register with the Received Date as the request date
        3. If there is both a LIS and MSP in the ECM, use the date on the first application received to register. Utilize information from both applications to process.
        4. On the FMD6/QMBDEC screen mark “Y” for QMB/SLMB only.
    2. Registering an LIS and MSP application WITH an IM-1SSL application.
        1. IM-1SSL is NOT requesting prior quarter.
            1. When you have an IM-1SSL and an LIS or MSP application, register using the date of the first application received to register.
            2. If an IM-1SSL is received with an IM-1MSP or LIS application and the IM-1SSL is marked no for prior quarter, staff will mark “N” on the application detail screen for prior quarter. The next day, after approval, staff will follow the WIBCA – Non-MAGI (Including PQ WIBCA) to enter WIBCAS for the MSP.
        2. IM-1SSL is requesting prior quarter.
            1. Mark “Y” for prior quarter on the application detail screen and process as normal.
        3. On the FMD6/QMBDEC screen mark “Y” for Add QMB/SLMB

 

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Active or Pending in MAGI or Non-MAGI #

When the applicant has active or pending MAGI or Non-MAGI follow the below instructions:

    1. Check MAGI to see applicant has an active MAGI
        1. If no active MAGI benefits, continue to Step 2.
        2. If active AEG, close AEG due to eligibility for Medicare.
            1. Refer to Managing an Integrated Case CIC/MAGI Annual Renewal to update the MAGI case with the applicant’s Medicare information and start the adverse action of closing AEG coverage.
            2. Continue to Step 2 to process MSP and Non-MAGI MO HealthNet.
        3. For all other MAGI programs, other than AEG, including MPW and participants who are 18 receiving social security and Medicare underneath a parent.
            1. Register the application in FAMIS and process the MSP.
            2. On the FMD6/QMBDEC screen mark “Y” for QMB/SLMB only.
    2. Check FAMIS to see applicant has an active or pending Non-MAGI
        1. If no active Non-MAGI, register and process the Non-MAGI application using information from the LIS/MSP applications and MEDES.
            1. A new IM-1SSL is not necessary.
            2. An IM-1ABDS is not necessary if an IM-1MSP was received. Use the application date for the date the IM-1ABDS was received.
            3. If the applicant has an LIS application and has not submitted an IM-1ABDS, staff will call and obtain the information needed. Request for Non-MAGI benefits can be discussed with the applicant at this time.  If caller does not answer, staff will send an FA-325 requesting only information that would be relevant to the eligibility of the LIS application.
                1. If pending for a source that does not have a proper title (i.e. checking account, but name of bank is unknown) label as ‘unknown’ in the system.
        2. If active or pending Non-MAGI, update/process the case by using information from FAMIS, MEDES, and from the LIS/MSP application.
          1. On the FMD6/QMBDEC screen mark “Y” for Add QMB/SLMB.

 

 

Buy-In Eligibility for Alternative Care Applicants #

If the applicant is in Alternative Care (AC) through Children’s Division, register and process the application per the instructions above, however FAMIS will reject the application due to the applicant being in AC.

    1. Determine if the person would be eligible for the program (income, resources, and technical criteria).
    2. Entered a trial budge on SELWIBCA.
    3. If the person is eligible:
        1. Send an email request to COLE.MHNPOLICY@dss.mo.gov with subject line “Buy-In for AC Participant”.
            1. Include the applicant’s name, DCN, and which level of buy-in for which the person is eligible (QMB or SLMB1).
        2. A return email will be sent when coverage has been entered.
        3. Send a manual approval letter (IM-32) to the applicant.

 

 

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