Current through Register Vol. 41, No. 3, September 23, 2024
The agency provides for making Medicare Prescription Drug
Low-Income Subsidy determinations under § 1935(a) of the Social Security
Act;
1. The agency makes
determinations of eligibility for premium and cost-sharing subsidies under and
in accordance with § 1860 D 14 of the Social Security Act;
a. The Social Security Administration's
subsidy application (SSA-1020) will be used as the official application form
for individuals to request that the state determine eligibility for the
Low-Income Subsidy.
b. The
application must be filed at the local department of social services in the
city or county where the applicant resides. A face-to-face interview is not
required.
c. The applicant may be
represented by an individual who is authorized to act on behalf of the
applicant; if the applicant is incapacitated or incompetent, someone acting
responsibly on his behalf; or an individual of the applicant's choice who is
requested by the applicant to act as his representative in the application
process. The person acting responsibly on behalf of, or acting as the
representative of the applicant is required to attest to the accuracy of the
information on the application.
d.
Applications must be acted on within 45 days from the date the application is
received by the local department of social services. A determination of
eligibility or ineligibility must be made and the applicant must be sent
written notice of his approval or denial of assistance under the Low-Income
Subsidy program as well as the reasons for such findings.
e. Redeterminations of eligibility must be
made in the same manner and frequency as redeterminations are required under
the state's Medicaid State Plan.
f.
Family size. The following persons are counted in the family size: the
applicant; the applicant's spouse, if living with the applicant; and any
persons who are related by blood, marriage or adoption, who are living with the
applicant and spouse and who are dependent on the applicant or spouse for at
least one-half of their financial support.
g. Financial requirements. Regulations at 20
CFR Part 416 Subparts K and L are used to evaluate income and resources for
subsidy eligibility. Current SSI policy can be found in the online Program
Operations Manual System (POMS) at
http://policy.ssa.gov/poms.nsf/aboutpoms.
Less restrictive rules the state uses for Medicaid determinations are not used
for the Low-Income Subsidy determination.
h. The subsidy applicant may appeal his
Low-Income Subsidy determination according to the appeal procedures found in
the state's Medicaid State Plan.
2. The agency provides for informing the
secretary of such determinations in cases in which such eligibility is
established or redetermined;
3. The
agency provides for screening of individuals for Medicare cost-sharing
described in § 1905(p)(3) of the Act and offering enrollment to eligible
individuals under the state plan or under a waiver of the state plan.
