Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS
Subchapter 11 - LOW INCOME SUBSIDY PROGRAM
Section 17-1722-90 - Benefits of the LIS program

Universal Citation: HI Admin Rules 17-1722-90

Current through August, 2024

The LIS program provides full or partial assistance with the subsidy for the coverage of the monthly premiums and cost-sharing related to Medicare part D to individuals based on the countable income of their households:

(1) Full benefit dual eligible individuals with countable income up to one hundred percent of the FPL shall be responsible for:

(A) The portion of the premium that exceeds the low income benchmark premium amount for basic coverage; and

(B) Co-payments.

(2) Full benefit dual eligible individuals above one hundred percent of the FPL, Medicare Savings Program beneficiaries, SSI recipients, and non-dual eligible individuals with countable income that does not exceed one hundred thirty-five percent of the FPL shall be responsible for:

(A) The portion of the premium that exceeds the low income benchmark premium amount for basic coverage; and

(B) Co-payments.

(3) Non-dual eligible individuals with income that exceeds one hundred thirty-five percent but does not exceed one hundred fifty percent of the FPL shall be responsible for:

(A) The portion of the monthly low income benchmark premium amount based on a sliding scale;

(B) A deductible;

(C) The co-insurance portion incurred with the Part D coverage gap; and

(D) Co-payments.

(4) Full benefit dual eligible individuals who are residing in a medical institution will not be subject to any cost-sharing related to Medicare part D.

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