Dual Eligibles Receiving Medicaid
HCBS Services
Now Have Zero Part D Copayments Under ACA
Effective
January 1, 2012, full-benefit dual eligibles receiving Medicaid home
and community based services (HCBS) have no Medicare Part D
copayments.
These
beneficiaries are eligible for a full waiver of copayment
requirements for their Medicare Part D prescription drugs. The
provision is designed to put people who are receiving HCBS in the
community on equal footing with those who are
institutionalized. Full duals who reside in skilled nursing
facilities already have no copayment liability.
If a full dual
receiving HCBS does not show as eligible for zero copays, the
individual may present evidence to her Part D plan showing HCBS
status. This Best Available Evidence (BAE) can include
documents dated after June 2011 showing state HCBS eligibility.
Advocates
should be alert to problems that may arise around state transmission
of HCBS data to CMS, and plan recognition of the new co-pay
status. Beneficiaries may also need assistance in
presenting BAE and in understanding the change in their co-payments.
To see details
about who qualifies, timing, length of qualification, expected
challenges and best available evidence policy, click here.
For further information, contact Georgia Burke,
gburke@nsclc.org.
