Q-1200, Medicare Improvement for Patients and Providers Act of 2008

Revision 22-3; Effective September 1, 2022

MIPPA added requirements for processing MSP applications for people applying through the Social Security Administration (SSA) for the Low Income Subsidy (LIS) program, also referred to as the Extra Help program. LIS provides prescription assistance for Medicare beneficiaries enrolled in Medicare Part D who have limited income and resources. The MSP programs included in MIPPA are:

  • Qualified Medicare Beneficiary (QMB) Program;
  • Specified Low-Income Medicare Beneficiary (SLMB) Program; and
  • Qualified Individual (QI) Program.

The Qualified Disabled and Working Individual (QDWI) Program is not part of MIPPA.

Texas receives a list of people who applied for LIS from SSA. The list includes whether the people were approved or denied. The date the Texas Health and Human Services Commission (HHSC) receives the list is the application date for MSP and starts the 45-day clock for timely processing of the applications for each person on the list. The date the application was made with SSA is a protected file date for MSP eligibility. Form H1200-EZ, Application for Assistance — Aged and Disabled is sent to each person on the list. HHSC sends denied LIS applicants a denial notice with the right to appeal if they are denied because they:

  • live outside the United States;
  • have excess resources; or
  • have excess income (couples will not auto deny).

Additionally, TIERS will deny anyone identified as living outside of Texas.