Low-Income Subsidy (“Extra Help”) for Dual Eligibles Receiving Home and Community-Based Services FAQ

From Justice in Aging: For More Info, Go Here…

ngd- This subsidy applies to people who are dual-eligible in Michigan and part of the demonstration program. It is a PDF document.

What is the cost-sharing rule for dual eligibles receiving Medicaid  Home and Community Based Services?

The Affordable Care Act provides that full-benefit dual eligibles—people who qualify for both Medicare and full Medicaid benefits—who receive certain Medicaid home- and community-based services (HCBS) are eligible for the institutional cost-sharing level on Medicare Part D prescription drugs.

The institutional cost-sharing level is $0 co-payments for all covered Part D drugs. The
provision is designed to put people who receive HCBS in the community on equal footing with those who are institutionalized.

Whom does the cost-sharing rule apply to?

The $0 cost-sharing level is available to individuals who:

(a) qualify for both Medicare and full-scope Medicaid benefits, also known as full-benefit dual eligibles, and
(b) also, receive HCBS under a state Medicaid plan, a Section 1115 waiver, a Section 1915(c) or Section 1915 (d) waiver, or through a Medicaid managed care organization.

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