MMIS: New Special Low-income Medicare Beneficiary (SLMB) Plus Enrollment

1. Department of Medical Assistance Services MMIS: New Special Low-income Medicare Beneficiary (SLMB) Plus Enrollment Department of Medical Assistance Services – Eligibility and Enrollment Unit February 2013 *REVISED http://www.dmas.virginia.gov 1

2. Agenda • Overview • New MMIS SLMB Plus Full-Medicaid Aid Categories (AC) • SLMB Plus Enrollments- • New enrollments: MN only and 300% group • Transition of current full coverage members to new SLMB Plus AC’s • Contacts

3. SLMB Plus Overview • At the federal level a SLMB Plus member is one who moves from SLMB to full-coverage. This term was not used previously in Virginia as designated AC’s were not available. • Reduce expenditures for Part B premium costs for certain members whose premiums are eligible for federal matching funds • Track the SLMB Plus population

4. SLMB Plus Overview • SLMB Plus AC definition is a member enrolled in Medicare Part A, with income > 100% FPL and <= 120% FPL • Members in these 4 new AC’s will be eligible for full coverage Medicaid and Part B premium payment.

5. Aid Categories Four new aid categories have been implemented for SLMB members who attain full coverage: • 024 MN Aged SLMB Plus • 044 MN Blind/Disabled SLMB Plus • 025 300% SSI aged SLMB Plus • 045 300% SSI blind/disabled SLMB Plus * Note: These are new MMIS enrollment aid categories; not new eligibility groups.

6. Transition to New AC’s • A current SLMB member will only transition to one of the new AC’s by; • Meeting a spenddown; • Reporting a change; • Reporting a need for long term-care (LTC); or • at Renewal, if the member would be SLMB only were it not for receipt of Medicaid LTC coverage

7. Transition to New AC’s – Disabled Example • A disabled member is found eligible for and enrolled in SLMB AC 053 effective 1/1/13. The member is placed on two six month spenddowns. • The member then submits medical bills which meet the spenddown liability on 3/1/13. The member meets all other MN financial requirements. • The member will now be enrolled in SLMB Plus AC 044 (MN Blind/Disabled) from 3/1-6/30/13.

8. Transition to New AC’s – LTC Example • An aged member is found eligible for and enrolled in SLMB AC 053 effective 1/1/13. • The member enters a nursing facility on 3/1/13. The member meets all LTC financial and nonfinancial requirements. • The member will now be enrolled in SLMB Plus AC 025 (300% SSI Aged).

9. Department of Medical Assistance Services When to Transition to New ACs • The transition to the new SLMB Plus AC’s will take at least 12 months for members who are currently enrolled in the 300% group. These members would be SLMB only if not for the receipt of Medicaid LTC. The transition should take place at renewal or a reported change. • As SLMB’s meet a Spenddown the new MN SLMB Plus ACs will be used to enroll the member in their SD eligibility period. *The use of SLMB Plus AC’s is effective 2/10/13 http://www.dmas.virginia.gov 9

10. New SLMB Plus Enrollments-Applicants • An applicant could be found eligible in a SLMB Plus AC if they would otherwise be eligible for SLMB Only limited coverage but for; • the need for long-term care has already been established or; • the applicant presents medical bills which meet their spenddown liability on the first day they would be eligible for coverage.

11. Department of Medical Assistance Services Member Meets Spenddown http://www.dmas.virginia.gov 11

12. Department of Medical Assistance Services Member Meets Spenddown http://www.dmas.virginia.gov 12

13. Department of Medical Assistance Services Summary • 4 new AC’s for SLMB Plus full-Medicaid • Transition to new AC’s will occur over the next 12 months based on; • Renewals • Reported changes • Member meeting spenddowns • All current procedures for MMIS data entry still apply for the new aid categories; • MMIS Coverage Correction forms should still be submitted to the DMAS Eligibility and Enrollment Unit Inbox: enrollment@dmas.virginia.gov • Questions regarding this training can be directed to: • mmiswebex@dmas.virginia.gov or • Sarah.samick@dmas.virginia.gov http://www.dmas.virginia.gov 13

14. Department of Medical Assistance Services Contacts Eligibility and Enrollment Unit: Enrollment Inbox: enrollment@dmas.virginia.gov Lois Brengel Sarah Samick lois.brengel@dmas.virginia.govsarah.samick@dmas.virginia.gov (804) 371-6333 (804) 786-4537 Policy Unit: Kelly Pauley Karen Packer kelly.pauley@dmas.virginia.govkaren.packer@dmas.virginia.gov (804) 786-7958 (804) 225-4101 Cindy Olson Cindy.olson@dmas.virginia.gov (804)225-4282 http://www.dmas.virginia.gov 14

15. Department of Medical Assistance Services Thank You! Send all questions and proposed topics for future trainings to the mmiswebex@dmas.virginia.gov email or you may contact Sarah Samick, Lead Enrollment Specialist: Email: sarah.samick@dmas.virginia.gov Phone: (804) 786-4537 Fax: (804) 225-4393 http://www.dmas.virginia.gov 15