In response to concerns from advocates for low-income Medicare beneficiaries (as raised in the CMA Weekly Alerts of June 3, 2004 and June 24, 2004), the Centers for Medicare & Medicaid Services (CMS) revised its policy concerning the effect on Medicaid eligibility of the transitional assistance ($600 credit) under the Medicare-endorsed prescription drug discount card.  CMS posted the following revised Question and Answer on its website, www.cms.hhs.gov/medicarereform, on Friday, July 2, at 4:44 p.m. 

Q: Will the availability of the $600 credit or discount prices prevent or delay an individual's eligibility for Medicaid under a "spenddown?" 

A: No.  Neither the $600 credit nor the discount prices will have a negative impact on the Medicaid eligibility process.  The discount and any portion of the $600 credit used for prescription drugs will be treated as incurred medical expenses for purposes of Medicaid spenddown, and there will be no delay in the onset of Medicaid eligibility.  CMS will issue guidance on how the Medicaid State agencies will calculate the applicant's level of drug spending to apply to "spenddown." 

This policy change is particularly important to participants in state pharmacy assistance programs (SPAPs) who are being automatically enrolled in the discount card program. The new policy finally clarifies that the $600 credit will not be used to deny or delay eligibility for Medicaid for people in a spend-down period.

© Copyright, Center for Medicare Advocacy, Inc. 05/05/2008