DRUG CARD TRANSITIONAL ASSISTANCE SHOULD NOT AFFECT MEDICAID ELIGIBILITY
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.gov/medicarereform,
on Friday, July 2, at 4:44 p.m.
Will the availability of the $600 credit or discount prices prevent or delay an
individual's eligibility for Medicaid under a "spenddown?"
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.
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