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Avisery Alert: Legal Assistance Updates

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Dear Avisery Members,

Below is an update on Avisery's referral pathway for legal assistance for problems with the Medicare Savings Program (MSP). In the Fall of 2020, we announced that individuals living in Cook County could potentially qualify for legal representation from Legal Aid Chicago. We are now expanding that referral pathway to residents of Central and Southern Illinois through a new partnership with Land of Lincoln Legal Aid.

Land of Lincoln Legal Aid provides free legal services to limited-income residents and seniors in 65 counties in central and southern Illinois and they would like to hear from Avisery partner agencies about problems with Medicare Savings Programs (MSP). MSPs are state Medicaid programs that pay a client’s monthly Medicare Part B premium and may cover additional Medicare costs. Medicare Savings Programs include the Qualified Medicare Beneficiary (QMB), Specified Low-Income Beneficiary (SLMB) or Qualified Individual (QI) programs. Once a Medicare beneficiary is approved for an MSP, a client should see Social Security stop deducting the monthly Part B premium from their Social Security check within 3-4 months. To learn more about MSPs, visit this link.

One specific way that clients can apply for an MSP is via applying for Social Security’s Extra Help Program. Extra Help is a federal program that covers some Medicare Part D-related costs for qualified individuals. The Extra Help application includes a statement notifying Illinois residents that their information will be sent to the Illinois Department of Human Services (DHS) to begin an MSP application unless the beneficiary specifically marks on the Extra Help application that they do not want their information sent to DHS.

Land of Lincoln and Legal Aid Chicago will evaluate all referrals from Avisery for potential legal representation, including direct advocacy with Illinois Department of Human Services (DHS) and/or filing of an administrative appeal.

MSP Issues Currently Being Referred
At this time, referrals are being accepted from clients in central and southern Illinois and in Cook County for the following issues:
1. A beneficiary who has been approved for MSP, but has continued to have their Part B premium deducted from their monthly Social Security check five months or more after approval.
2. A beneficiary who was already receiving Medicaid benefits at the time they were enrolled in Medicare Part A and DHS did not automatically evaluate the client for MSP eligibility. Under DHS rules, when a client on Medicaid begins receiving Medicare Part A, DHS should automatically assess for MSP and enroll the client if eligible.
3. A beneficiary who applied and was approved for Extra Help through Social Security, but has never received any information or notice from DHS about the Medicare Savings Program. The beneficiary must currently not have an MSP.

Land of Lincoln Legal Aid and Legal Aid Chicago both have a track record for resolving these issues. The appeal process not only ensures clients receive their MSP benefits going forward, but can result in DHS reimbursing beneficiaries for Part B premiums they paid out-of-pocket because DHS failed to evaluate their eligibility for MSP in the past. In some cases, these reimbursements may go back years.

If you identify a client with one of the issues, please email Avisery at avisery@ageoptions.org. We will follow up with you to collect the information required to forward the referral information to the appropriate legal assistance provider, who will then contact the client. We ask that you do not email client sensitive information directly to Avisery, but have the following information ready to relay to us when we contact you:
1. Beneficiary’s name, contact information, county of residence, date of birth and last four digits of their SSN
2. Date MSP application was submitted
3. Date of MSP approval
4. Date or copy of any notice received from DHS or Social Security regarding MSP
5. Date beneficiary started receiving Medicaid
6. Medicare Part A and Part B effective date
7. Date MSP started paying the beneficiary’s Part B premium
8. Date Extra Help application was submitted (if applicable)
9. Date or copy of any notice from SSA regarding Extra Help

As always, if you have any questions, please do not hesitate to contact us at avisery@ageoptions.org or call 708-628-3440.