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SUSTAINABLE COMMUNITIES Ashish Kothari’s “A Tapestry levitra canada for sale of Alternatives” explores ways of living around the world that offer inspirations for sustainability. The article is hopeful and enlightening, but Kothari may wish to consider the value of self-defense. Inevitably, in the “tapestry of alternatives” that he describes, there will levitra canada for sale arise knots of powers with values at odds with these communities.

They will, because they can, seek the goods of the commons. What’s to stop them?. Ultimately it will be countervailing power exercised as self-defense, which is not in conflict with the other core values, levitra canada for sale as any well-trained and disciplined martial artist knows.

By the way, there are thousands of local schools and traditions of martial arts that rightly should be considered part of the sphere of “cultural diversity and knowledge democracy” highlighted in the article. BILL CIPRA Overland Park, Kan. I wish to levitra canada for sale commend you for publishing Kothari’s article on the global “development” predicament.

Too many people in the scientific arena assume that technological advances will be able to solve our problems while allowing the pursuit of normal development to continue delivering affluent lifestyles and ever growing gross domestic product. But an increasing number of people can see that we are on the road to catastrophic global breakdown, primarily because there is far too much producing and consuming going on, and our economic and cultural systems are fiercely levitra canada for sale committed to increasing the levels without limit. We cannot get to a sustainable and just world unless and until the conventional development paradigm is scrapped, and we shift to some kind of simpler way (see https://thesimplerway.info).

TED TRAINER via e-mail KOTHARI REPLIES. Cipra makes levitra canada for sale an important point. Indeed, the transitions toward an eco-swaraj—a community that practices self-rule merged with ecological sustainability—will face many such challenges.

In my understanding, the values of “autonomy” or “self-determination,” which are part of the vision, include the means and tools that are necessary to sustain them. Self-defense would levitra canada for sale be part of this. How precisely people and communities defend their autonomy could vary greatly.

Some movements have armed themselves with the explicit intention to use armed tactics only for self-defense, never for offense. And many others use Gandhian tactics of nonviolent defense levitra canada for sale. Indeed, the vast diversity of “martial” arts are part of cultural diversity, except that their use, if it is to be in sync with the values of eco-swaraj, would never be for offensive actions that proactively take away the autonomy and freedom of others.

This is, of course, a complex subject and not possible to deal with satisfactorily in a brief comment levitra canada for sale. MYSTERY OF MIND Christof Koch ends “The Brain Electric” with this most fundamental question. €œWhat is it about the brain ...

That turns the activity of 86 billion neurons into the feeling of life levitra canada for sale itself?. € Variations of Koch’s provocative question about consciousness have, of course, dogged philosophers for millennia. Among the most influential was 20th-century British philosopher Gilbert Ryle, who put to rest the wrongheadedness of Cartesian mind-body dualism by metaphorically debunking this notion as the “ghost in the machine.” Philosophers have since handed the baton off to neuroscientists, physicists and other scientists to figure out how the brain gives rise to consciousness.

KEITH TIDMAN levitra canada for sale Bethesda, Md. SCIENCE AND POLITICS In response to “Do Republicans Mistrust Science?. ,” by Naomi Oreskes [Observatory], I feel compelled to levitra canada for sale point out that trust is a two-way street.

By mandating behaviors such as wearing masks to fight erectile dysfunction treatment or using taxes and incentives to influence consumer choices to fight climate change, those in government are essentially saying that they don’t trust us citizens to inform ourselves and make sound choices. Republicans strongly value individual liberties. So to them, the issue is the way the science is used by the government to justify further levitra canada for sale intrusions on the lives of its citizens.

Admittedly, some mistakenly feel the best way to fight back against such intrusions is to deceptively cast doubt on the science itself (as Oreskes points out has been done with both climate change and erectile dysfunction treatment). Although I strongly disagree with this tactic, I am sympathetic with its motivation. I and many others have a strong conviction that a free and open society is best served by a government that informs and empowers its citizens levitra canada for sale rather than one that treats us like we can’t help ourselves.

GERALD SONTHEIMER St. Louis, Mo. NOT-FOR-PROFIT DRUGS levitra canada for sale “Deadly Kingdom,” by Maryn McKenna, is a real wake-up call.

Not only are levitraes and bacteria a deadly threat, but now fungal diseases (which are far more difficult to treat) are an even greater one. The bigger problem, however, is that big pharma has refused to adequately develop new antiviral, antibacterial levitra canada for sale and antifungal medications because they are not profitable enough. The erectile dysfunction treatments are not a valid example of the pharmaceutical industry rapidly developing treatments on its own.

Most of the mRNA treatment research had already been done, and the U.S. Government guaranteed that levitra canada for sale the industry would not lose any money if its treatments failed. Further, the so-called free treatments were fully paid for by taxpayers, as are the half a billion doses the U.S.

Has pledged to “donate” to the world. This is one more example of how capitalism, with its profit motive requirement, cannot meet the needs of the vast majority of the levitra canada for sale world’s population. JOHN JAROS Philadelphia EIGHT-ARMED BANDIT “A Model Octopus,” by Rachel Nuwer [Advances.

March 2021], quotes multiple experts discussing the potential of big-brained cephalopods for widening the scope of research on animal intelligence. Visiting an aquarium in England, I was shown a specimen levitra canada for sale with a 40-inch arm span that local fishers had brought in. I was told of a series of overnight thefts of fish that had been disturbing the staff.

Because the perimeter security of the aquarium was uncompromised, it looked to be an insider job, levitra canada for sale casting shadows on everybody. All-night surveillance cameras were installed to try and work out what was going on. The cameras revealed the octopus sliding outside of its tank and creeping across the floor to another tank of its choice.

After helping itself to a neighbor as a late-night meal, it made the return journey to its own tank and climbed back inside, carefully pulling the lid back into its original position before settling down to digest its levitra canada for sale illicit meal. ALAN WALLER via e-mail ERRATA “Deadly Kingdom,” by Maryn McKenna, should have said that unlike animals, fungi have cell walls in addition to cellular membranes, not in place of them. In “Fabric from Fungi,” by Cypress Hansen [Advances], the photograph of an agarikon fungus was upside down.

Additionally, Deborah Tear Haynes’s position at Dartmouth College’s Hood Museum of Art should have been described as “collections documentation manager,” not “collections manager.”Researchers in Arizona have found that urban heat islands made levitra canada for sale worse by sun-baked asphalt roads can be mitigated by a relatively simple measure. Paint the streets gray. A study by Arizona State University and the city of Phoenix found that applying a reflective, gray-colored emulsion material to black asphalt resulted in a 10.5- to 12-degree-Fahrenheit drop in average road surface temperatures, while sunrise temperatures saw levitra canada for sale an average 2.4-degree drop.

€œThis is exactly what we were hoping for,” Phoenix Mayor Kate Gallego said in a statement. €œWhile there’s work to be done, it’s exciting to see a technology that has the potential to meet the demands of a growing desert city in a world where temperatures are constantly rising.” Experts say road temperatures in the Phoenix area can rise to 180 degrees on a hot day. That absorbed energy remains in paved surfaces for hours, radiating levitra canada for sale heat back into nighttime air.

Higher overnight temperatures result in warmer mornings, creating a cycle of urban heat island effect. Researchers found that the greatest temperature differential was near the road surface, with less dramatic results 6 feet above the ground. Even so, the neighborhoods with reflective levitra canada for sale streets experienced air temperatures 0.3 degree cooler during the day and 0.5 degree cooler overnight compared with neighborhoods with black-topped roads.

But reflective pavements don’t affect all surfaces the same way. Ariane Middel, an urban climatologist and assistant professor at Arizona State, said in a release that “the most meaningful measurement” was of radiant temperatures, a measure of how the body experiences heat. Those measurements—taken by researchers walking treated streets pulling a small cart equipped with meteorological sensors—showed that the “human experience of heat exposure at noon and the afternoon hours was higher due to surface reflectivity, but similar to walking on a typical concrete sidewalk.” Researchers said the increase in felt temperatures “may be levitra canada for sale a necessary trade-off to reduce surface temperatures using a reflective surface.” Heather Murphy, a spokesperson for the Phoenix Street Transportation Department, said the response has been mixed from drivers and residents in neighborhoods where the material is applied.

€œWe have had some people who don’t like the aesthetics of it, but generally the response has been very positive,” she said. She said the department levitra canada for sale fielded questions early on about glare and visibility, but when dry, the coating has no effect on driver visibility. €œIt looks just like the road surface you see on an interstate highway.” The coating, called CoolSeal, is a water-based asphalt emulsion made by California-based GuardTop, but it is not available for purchase by individuals or homeowners, Murphy said.

The company’s website said it completed a product demonstration last December for the city of Los Angeles’ Bureau of Street Services. Still, officials cautioned that levitra canada for sale reflective pavement is not a panacea for the urban heat island effect. €œIf you’re standing over one of these surfaces on a hot day, you’re still going to be hot if you’re not in the shade,” said Jennifer Vanos, an assistant professor at Arizona State’s School of Sustainability who worked on the study.

€œSo if we really want to be pushing towards true solutions to the heat problems, it’s not going to be just paint all the streets white.” A second phase of the study is forthcoming and will examine questions about how the material performs under varying conditions, including changes in reflectivity, traction/skid, degradation and subsurface temperature over longer periods. Reprinted from E&E News with permission from levitra canada for sale POLITICO, LLC. Copyright 2021.

E&E News provides essential news for energy and environment professionals..

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MDEL Bulletin, June 15, 2021, from the Medical Devices Compliance Program On this page Rapid antigen tests and the workplace screening initiative There are currently various technologies to detect SARS CoV-2, the levitra levitra canada online that causes Visit Your URL erectile dysfunction treatment. Antigen-based testing devices detect specific proteins on the surface of the levitra and typically provide results in less than 1 hour. While some rapid antigen detection tests (RADTs) have been approved for people without symptoms, most RADTs are indicated for use on people with symptoms and are to be conducted by laboratory personnel, healthcare professionals or trained operators. Health Canada has authorized several RADTs under two interim orders levitra canada online. The indications and conditions of use of authorized products may change over time as manufacturers continue to collect data.

Screening asymptomatic individuals for SARS CoV-2 is proving to be effective in high-risk settings where social distancing and other measures are not feasible. Through the workplace levitra canada online screening initiative, Canada is supplying RADTs to eligible workplaces across the country. The initiative will help companies detect early cases of erectile dysfunction treatment, for people who are asymptomatic. This initiative is being administered in collaboration with the provinces and territories. Interim enforcement approach In the interest of public health, Health Canada is placing less priority on enforcing off-label distribution of RADTs under the following circumstances.

While some rapid antigen detection tests (RADTs) have been approved for people without symptoms, most RADTs are indicated for use on people with symptoms and are to be conducted by laboratory personnel, healthcare professionals levitra canada for sale or i thought about this trained operators. Health Canada has authorized several RADTs under two interim orders. The indications and conditions of use of authorized products may change over time as manufacturers continue to collect data. Screening asymptomatic individuals for SARS CoV-2 is proving to be effective levitra canada for sale in high-risk settings where social distancing and other measures are not feasible.

Through the workplace screening initiative, Canada is supplying RADTs to eligible workplaces across the country. The initiative will help companies detect early cases of erectile dysfunction treatment, for people who are asymptomatic. This initiative levitra canada for sale is being administered in collaboration with the provinces and territories. Interim enforcement approach In the interest of public health, Health Canada is placing less priority on enforcing off-label distribution of RADTs under the following circumstances.

This enforcement discretion will be in effect until December 31, 2021. The exception is if.

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Side effects that you should report to your prescriber or health care professional as soon as possible.

• back pain
• changes in hearing such as loss of hearing or ringing in ears
• changes in vision such as loss of vision, blurred vision, eyes being more sensitive to light, or trouble telling the difference between blue and green objects or objects having a blue color tinge to them
• chest pain or palpitations
• difficulty breathing, shortness of breath
• dizziness
• eyelid swelling
• muscle aches
• prolonged erection (lasting longer than 4 hours)
• skin rash, itching
• seizures

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• flushing
• headache
• indigestion
• nausea
• stuffy nose

This list may not describe all possible side effects.

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Latest Mental Health News levitra dosage generic MONDAY, May 31, 2021 (HealthDay News) Many Americans have used telehealth and would turn to Find Out More it for mental health care, a new online poll shows. Conducted by the American Psychological Association (APA) from March 26 to April 5, the poll found that 38% had used telehealth to consult with a health professional, up from 31% last fall. In all, levitra dosage generic 82% have used it since the start of the levitra, the poll found. Most consultations were done via video (69%). Thirty-eight percent of respondents said they had used phone calls only.

"The quick pivot to providing telehealth services at the start of the levitra was vital to providing continued access to care, and this poll shows the important potential role for telehealth levitra dosage generic going forward," said APA President Dr. Vivian Pender. "Telepsychiatry especially helps those facing barriers such as lack of transportation, the inability to take time off work for appointments, or family responsibilities," she added in an APA news release. The poll found that confidence in telehealth is levitra dosage generic growing. Respondents were slightly more likely this year than last to say telehealth can provide the same quality care as in-person services (45% versus 40%), and that they would use telehealth for mental health services (59% versus 49%).

In the new survey, 66% of 18- to 29-year-olds said they would do so, compared to 36% of seniors. Similar percentages (between 58% and 61% each) of Black respondents, Hispanic respondents and white respondents said they levitra dosage generic would use telehealth for mental health care. Overall, about 43% of respondents said they want to continue using telehealth when the levitra is over and 34% said they'd prefer it to an office visit — up from 31% in 2020. Acceptance was highest among 18- to 44-year-olds, at levitra dosage generic 45%. The survey also found that 57% of respondents would consider using a support line or online chat when struggling with personal difficulty and mental anxiety, and 7% said they had already done so.

Only 21% would not consider it. The online poll has a margin of error levitra dosage generic of plus or minus 3.1 percentage points. More information The U.S. Department of Health and Human Services has more on telehealth. SOURCE.

American Psychological Association, news release, May 27, 2021 Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Health Care Reform. Protect Your Health in a Rough Economy See SlideshowLatest Healthy Kids News MONDAY, May 31, 2021 (HealthDay News) People aren't born understanding social norms, but kids do have a desire to fit in with the crowd from an early age, according to a new study. Researchers from Duke University in Durham, N.C.

Found that when 3-year-olds were asked to behave in a certain way and did so, they weren't conforming just to obey an adult, but were going along with the group. Kids begin to pick up on society's unwritten social rules, such as eating with a fork instead of their hands or covering their cough, when they are very young, according to the study. Researchers asked 104 preschoolers, age 3 1/2, to help set up a pretend tea party. At the start, they gave each child a blue sticker and told them that people with that color sticker were part of the same team. Then, researchers watched as the kids made decisions about teas, snacks, cups and plates for the party, first on their own and then after hearing others' choices.

Sometimes other team members framed their choice as a matter of personal preference ("For my tea party today, I feel like using this snack"). Other times, they presented it as a norm shared by the whole group. "For tea parties at Duke, we always use this kind of snack." After hearing others' choices, kids usually stayed with their first choice. But 23% of the time, they switched to someone else's. When they did, they were more likely to go along when an option was presented as a group norm rather than just a personal preference.

This was true even when the other person was a child, not an adult. Researchers said this suggested that the preschoolers weren't simply acting out of a desire to imitate adults or obey authority. First author Leon Li, a doctoral student in psychology and neuroscience, is a member of Duke's Tomasello Lab. He said the findings lend support to an idea proposed by lab director Michael Tomasello, a psychology and neuroscience professor, and colleagues about how kids develop the moral reasoning that sets humans apart from other animals. When an adult says to an infant or a toddler, "we don't hit," the child generally does as she's told out of deference to that person, according to researchers.

Eventually, though, their way of thinking changes. They begin to understand cues such as "we don't hit" as something larger, coming from the group, and act out of a sense of connectedness and shared identity, researchers said. "Every culture has its do's and don'ts," Li said in a university news release. The findings were published May 26 in the journal PLOS ONE. More information The U.S.

Centers for Disease Control and Prevention has information on communicating with your child. SOURCE. Duke University, news release, May 27, 2021 Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Healthy Eating for Kids - Recipes and Meal Ideas See SlideshowLatest Pregnancy News MONDAY, May 31, 2021 (HealthDay News) Women who are struggling to get pregnant, beware of false dietary supplements that claim to help cure infertility and other reproductive health issues.

Such supplements are not approved by the U.S. Food and Drug Administration and they could prevent patients from seeking effective, approved drugs, the agency warned. "These purported fertility aids seek to profit off of the vulnerability and frustration many may feel as they face difficulties in getting pregnant," the FDA said in a news release. "Relying on ineffective, unproven products can be a waste of time and money, and can possibly result in illness or serious injury." The agency noted that most of these unapproved drugs are sold online and many are falsely labeled as dietary supplements. "It is important to know that these products are not based on proven scientific information, and they have not been reviewed for safety and efficacy," the FDA said.

Sellers of unproven infertility or pregnancy-related therapies often make unsupported claims about the supposed effectiveness of their products, including fake consumer testimonials. FDA said the fake testimonials include statements such as these. "You will get pregnant very fast and give birth to healthy children regardless of … how severe or chronic your infertility disorder." " … a perfect natural alternative to infertility drugs or invasive treatments." "best fertility supplements to boost your chance of pregnancy or improve your IVF success rate." "… treat infertility… effectiveness in preventing recurrent miscarriages during early stage pregnancy." Other false claims include. "One product does it all" or "Miracle cure" or "scientific breakthrough" or "cure all." Before buying or using any over-the-counter product, including those labeled as dietary supplements, you should talk to your health care provider, the FDA said. About 12% of 15- to 44-year-old women in the United States have difficulty becoming pregnant or carrying a pregnancy to term, according to the U.S.

Centers for Disease Control and Prevention. More information The U.S. National Institute of Child Health and Human Development has more on infertility treatments. SOURCE. U.S.

Food and Drug Administration, news release, May 26, 2021 Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Fertility Options. Types, Treatments, and Costs See Slideshow.

Latest Mental Health News MONDAY, May 31, 2021 (HealthDay News) Many Americans have used levitra canada for sale telehealth and would turn to it for mental health care, a new online poll shows. Conducted by the American Psychological Association (APA) from March 26 to April 5, the poll found that 38% had used telehealth to consult with a health professional, up from 31% last fall. In all, 82% have used it since levitra canada for sale the start of the levitra, the poll found. Most consultations were done via video (69%). Thirty-eight percent of respondents said they had used phone calls only.

"The quick pivot to providing telehealth services at the start of the levitra was vital levitra canada for sale to providing continued access to care, and this poll shows the important potential role for telehealth going forward," said APA President Dr. Vivian Pender. "Telepsychiatry especially helps those facing barriers such as lack of transportation, the inability to take time off work for appointments, or family responsibilities," she added in an APA news release. The poll levitra canada for sale found that confidence in telehealth is growing. Respondents were slightly more likely this year than last to say telehealth can provide the same quality care as in-person services (45% versus 40%), and that they would use telehealth for mental health services (59% versus 49%).

In the new survey, 66% of 18- to 29-year-olds said they would do so, compared to 36% of seniors. Similar percentages (between 58% and 61% each) of Black respondents, Hispanic respondents and white respondents said they would use telehealth for mental levitra canada for sale health care. Overall, about 43% of respondents said they want to continue using telehealth when the levitra is over and 34% said they'd prefer it to an office visit — up from 31% in 2020. Acceptance was levitra canada for sale highest among 18- to 44-year-olds, at 45%. The survey also found that 57% of respondents would consider using a support line or online chat when struggling with personal difficulty and mental anxiety, and 7% said they had already done so.

Only 21% would not consider it. The online poll has a margin of error of plus or minus levitra canada for sale 3.1 percentage points. More information The U.S. Department of Health and Human Services has more on telehealth. SOURCE.

American Psychological Association, news release, May 27, 2021 Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Health Care Reform. Protect Your Health in a Rough Economy See SlideshowLatest Healthy Kids News MONDAY, May 31, 2021 (HealthDay News) People aren't born understanding social norms, but kids do have a desire to fit in with the crowd from an early age, according to a new study. Researchers from Duke University in Durham, N.C.

Found that when 3-year-olds were asked to behave in a certain way and did so, they weren't conforming just to obey an adult, but were going along with the group. Kids begin to pick up on society's unwritten social rules, such as eating with a fork instead of their hands or covering their cough, when they are very young, according to the study. Researchers asked 104 preschoolers, age 3 1/2, to help set up a pretend tea party. At the start, they gave each child a blue sticker and told them that people with that color sticker were part of the same team. Then, researchers watched as the kids made decisions about teas, snacks, cups and plates for the party, first on their own and then after hearing others' choices.

Sometimes other team members framed their choice as a matter of personal preference ("For my tea party today, I feel like using this snack"). Other times, they presented it as a norm shared by the whole group. "For tea parties at Duke, we always use this kind of snack." After hearing others' choices, kids usually stayed with their first choice. But 23% of the time, they switched to someone else's. When they did, they were more likely to go along when an option was presented as a group norm rather than just a personal preference.

This was true even when the other person was a child, not an adult. Researchers said this suggested that the preschoolers weren't simply acting out of a desire to imitate adults or obey authority. First author Leon Li, a doctoral student in psychology and neuroscience, is a member of Duke's Tomasello Lab. He said the findings lend support to an idea proposed by lab director Michael Tomasello, a psychology and neuroscience professor, and colleagues about how kids develop the moral reasoning that sets humans apart from other animals. When an adult says to an infant or a toddler, "we don't hit," the child generally does as she's told out of deference to that person, according to researchers.

Eventually, though, their way of thinking changes. They begin to understand cues such as "we don't hit" as something larger, coming from the group, and act out of a sense of connectedness and shared identity, researchers said. "Every culture has its do's and don'ts," Li said in a university news release. The findings were published May 26 in the journal PLOS ONE. More information The U.S.

Centers for Disease Control and Prevention has information on communicating with your child. SOURCE. Duke University, news release, May 27, 2021 Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Healthy Eating for Kids - Recipes and Meal Ideas See SlideshowLatest Pregnancy News MONDAY, May 31, 2021 (HealthDay News) Women who are struggling to get pregnant, beware of false dietary supplements that claim to help cure infertility and other reproductive health issues.

Such supplements are not approved by the U.S. Food and Drug Administration and they could prevent patients from seeking effective, approved drugs, the agency warned. "These purported fertility aids seek to profit off of the vulnerability and frustration many may feel as they face difficulties in getting pregnant," the FDA said in a news release. "Relying on ineffective, unproven products can be a waste of time and money, and can possibly result in illness or serious injury." The agency noted that most of these unapproved drugs are sold online and many are falsely labeled as dietary supplements. "It is important to know that these products are not based on proven scientific information, and they have not been reviewed for safety and efficacy," the FDA said.

Sellers of unproven infertility or pregnancy-related therapies often make unsupported claims about the supposed effectiveness of their products, including fake consumer testimonials. FDA said the fake testimonials include statements such as these. "You will get pregnant very fast and give birth to healthy children regardless of … how severe or chronic your infertility disorder." " … a perfect natural alternative to infertility drugs or invasive treatments." "best fertility supplements to boost your chance of pregnancy or improve your IVF success rate." "… treat infertility… effectiveness in preventing recurrent miscarriages during early stage pregnancy." Other false claims include. "One product does it all" or "Miracle cure" or "scientific breakthrough" or "cure all." Before buying or using any over-the-counter product, including those labeled as dietary supplements, you should talk to your health care provider, the FDA said. About 12% of 15- to 44-year-old women in the United States have difficulty becoming pregnant or carrying a pregnancy to term, according to the U.S.

Centers for Disease Control and Prevention. More information The U.S. National Institute of Child Health and Human Development has more on infertility treatments. SOURCE. U.S.

Food and Drug Administration, news release, May 26, 2021 Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Fertility Options. Types, Treatments, and Costs See Slideshow.

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Those consumers can qualify for MIPP and have their compare levitra and viagra Part B premiums reimbursed. Here is an example. Sam is age 50 and has Medicare and MBI-WPD. She gets compare levitra and viagra $1500/mo gross from Social Security Disability and also makes $400/month through work activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies.

$400 - $65 = $335. Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability compare levitra and viagra = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2. Parent/Caretaker Relatives with MAGI-like Budgeting compare levitra and viagra - Including Medicare Beneficiaries.

Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or compare levitra and viagra lower than 120% of the FPL. If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP.

(See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) compare levitra and viagra to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP. However, the transition time can vary based on age. AGE 65+ Those who enroll in Medicare at age 65+ will receive a letter from compare levitra and viagra their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02.

The Medicaid case takes about four months to be rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments for compare levitra and viagra at least three months during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP, even if the LDSS determines the consumer is not eligible for Medicaid because of excess income or assets. 08 OHIP/ADM-4. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 compare levitra and viagra months (also known as continuous coverage, See NY Social Services Law 366, subd.

4(c). These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS. NOTE during compare levitra and viagra erectile dysfunction treatment emergency their case may remain with NYSoH for more than 12 months. See here. EXAMPLE.

Sam, age 60, was last authorized for Medicaid on the compare levitra and viagra Marketplace in June 2020. He became enrolled in Medicare based on disability in August 2020, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2020. Sam has to pay for his Part B premium - compare levitra and viagra it is deducted from his Social Security check. He may call the Marketplace and request a refund.

This will continue until the end of his 12 months of continuous MAGI Medicaid eligibility. He will be compare levitra and viagra reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. That directive also clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed compare levitra and viagra care (MMC) plan.

Note. During the erectile dysfunction treatment emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should compare levitra and viagra keep the same MAGI budgeting and automatically receive MIPP payments. See GIS 20 MA/04 or this article on erectile dysfunction treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC).

Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of compare levitra and viagra their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this compare levitra and viagra article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down.

Therefore, they are eligible for payment of their Part B premiums. See page 96 of compare levitra and viagra the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11 compare levitra and viagra.

Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &. 1619B. 5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit.

The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021). They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019. Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check.

In contrast, MSP enrollees are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as. A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only.

Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &. Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment.

Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP. If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS.

See more here about consumers who have Medicaid on NYSofHealth who then enroll in Medicare - how they access MIPP. Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing.

See attached sample for what to look for. Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualify enrollees for the "Extra Help" subsidy for Part D prescription drugs. There are three separate MSP programs, the Qualified Medicare Beneficiary (QMB) Program, the Specified Low Income Medicare Beneficiary (SLMB) Program and the Qualified Individual (QI) Program, each of which is discussed below. Those in QMB receive additional subsidies for Medicare costs. See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH State law.

N.Y. Soc. Serv. L. § 367-a(3)(a), (b), and (d).

2020 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric Hausman, sponsored by NYS Office of the Aging Note. Some consumers may be eligible for the Medicare Insurance Premium Payment (MIPP) Program, instead of MSP. See this article for more info. TOPICS COVERED IN THIS ARTICLE 1. No Asset Limit 1A.

Summary Chart of MSP Programs 2. Income Limits &. Rules and Household Size 3. The Three MSP Programs - What are they and how are they Different?. 4.

FOUR Special Benefits of MSP Programs. Back Door to Extra Help with Part D MSPs Automatically Waive Late Enrollment Penalties for Part B - and allow enrollment in Part B year-round outside of the short Annual Enrollment Period No Medicaid Lien on Estate to Recover Payment of Expenses Paid by MSP Food Stamps/SNAP not reduced by Decreased Medical Expenses when Enroll in MSP - at least temporarily 5. Enrolling in an MSP - Automatic Enrollment &. Applications for People who Have Medicare WHO IS AUTOMATICALLY ENROLLED IN AN MSP Applying for MSP Directly with Local Medicaid Program - including those who already have Medicaid through local Medicaid program but need MSP, and those newly applying for MSP Enrolling in an MSP if you have Medicaid and Just Became Eligible for Medicare MIPPA - SSA Notifies Social Security recipients that they may be eligible for MSP based on their income. 6.

Enrolling in an MSP for People age 65+ who Do Not Qualify for Free Medicare Part A - the "Part A Buy-In Program" 7. What Happens After MSP Approved - How Part B Premium is Paid 8 Special Rules for QMBs - How Medicare Cost-Sharing Works 1. NO ASSET LIMIT!. Since April 1, 2008, none of the three MSP programs have resource limits in New York -- which means many Medicare beneficiaries who might not qualify for Medicaid because of excess resources can qualify for an MSP. 1.A.

SUMMARY CHART OF MSP BENEFITS QMB SLIMB QI-1 Eligibility ASSET LIMIT NO LIMIT IN NEW YORK STATE INCOME LIMIT (2021) Single Couple Single Couple Single Couple $1,094 $1,472 $1,308 $1,762 $1,469 $1,980 Federal Poverty Level 100% FPL 100 – 120% FPL 120 – 135% FPL Benefits Pays Monthly Part B premium?. YES, and also Part A premium if did not have enough work quarters and meets citizenship requirement. See “Part A Buy-In” YES YES Pays Part A &. B deductibles &. Co-insurance YES - with limitations NO NO Retroactive to Filing of Application?.

Yes - Benefits begin the month after the month of the MSP application. 18 NYCRR §360-7.8(b)(5) Yes – Retroactive to 3rd month before month of application, if eligible in prior months Yes – may be retroactive to 3rd month before month of applica-tion, but only within the current calendar year. (No retro for January application). See GIS 07 MA 027. Can Enroll in MSP and Medicaid at Same Time?.

YES YES NO!. Must choose between QI-1 and Medicaid. Cannot have both, not even Medicaid with a spend-down. 2. INCOME LIMITS and RULES Each of the three MSP programs has different income eligibility requirements and provides different benefits.

The income limits are tied to the Federal Poverty Level (FPL). 2021 FPL levels were released by NYS DOH in GIS 21 MA/06 - 2021 Federal Poverty Levels Attachment II NOTE. There is usually a lag in time of several weeks, or even months, from January 1st of each year until the new FPLs are release, and then before the new MSP income limits are officially implemented. During this lag period, local Medicaid offices should continue to use the previous year's FPLs AND count the person's Social Security benefit amount from the previous year - do NOT factor in the Social Security COLA (cost of living adjustment). Once the updated guidelines are released, districts will use the new FPLs and go ahead and factor in any COLA.

See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH Income is determined by the same methodology as is used for determining in eligibility for SSI The rules for counting income for SSI-related (Aged 65+, Blind, or Disabled) Medicaid recipients, borrowed from the SSI program, apply to the MSP program, except for the new rules about counting household size for married couples. N.Y. Soc. Serv. L.

367-a(3)(c)(2), NYS DOH 2000-ADM-7, 89-ADM-7 p.7. Gross income is counted, although there are certain types of income that are disregarded. The most common income disregards, also known as deductions, include. (a) The first $20 of your &. Your spouse's monthly income, earned or unearned ($20 per couple max).

(b) SSI EARNED INCOME DISREGARDS. * The first $65 of monthly wages of you and your spouse, * One-half of the remaining monthly wages (after the $65 is deducted). * Other work incentives including PASS plans, impairment related work expenses (IRWEs), blind work expenses, etc. For information on these deductions, see The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) and other guides in this article -- though written for the MBI-WPD, the work incentives apply to all Medicaid programs, including MSP, for people age 65+, disabled or blind. (c) monthly cost of any health insurance premiums but NOT the Part B premium, since Medicaid will now pay this premium (may deduct Medigap supplemental policies, vision, dental, or long term care insurance premiums, and the Part D premium but only to the extent the premium exceeds the Extra Help benchmark amount) (d) Food stamps not counted.

You can get a more comprehensive listing of the SSI-related income disregards on the Medicaid income disregards chart. As for all benefit programs based on financial need, it is usually advantageous to be considered a larger household, because the income limit is higher. The above chart shows that Households of TWO have a higher income limit than households of ONE. The MSP programs use the same rules as Medicaid does for the Disabled, Aged and Blind (DAB) which are borrowed from the SSI program for Medicaid recipients in the “SSI-related category.” Under these rules, a household can be only ONE or TWO. 18 NYCRR 360-4.2.

See DAB Household Size Chart. Married persons can sometimes be ONE or TWO depending on arcane rules, which can force a Medicare beneficiary to be limited to the income limit for ONE person even though his spouse who is under 65 and not disabled has no income, and is supported by the client applying for an MSP. EXAMPLE. Bob's Social Security is $1300/month. He is age 67 and has Medicare.

His wife, Nancy, is age 62 and is not disabled and does not work. Under the old rule, Bob was not eligible for an MSP because his income was above the Income limit for One, even though it was well under the Couple limit. In 2010, NYS DOH modified its rules so that all married individuals will be considered a household size of TWO. DOH GIS 10 MA 10 Medicare Savings Program Household Size, June 4, 2010. This rule for household size is an exception to the rule applying SSI budgeting rules to the MSP program.

Under these rules, Bob is now eligible for an MSP. When is One Better than Two?. Of course, there may be couples where the non-applying spouse's income is too high, and disqualifies the applying spouse from an MSP. In such cases, "spousal refusal" may be used SSL 366.3(a). (Link is to NYC HRA form, can be adapted for other counties).

In NYC, if you have a Medicaid case with HRA, instead of submitting an MSP application, you only need to complete and submit MAP-751W (check off "Medicare Savings Program Evaluation") and fax to (917) 639-0837. (The MAP-751W is also posted in languages other than English in this link. (Updated 4/14/2021.)) 3. The Three Medicare Savings Programs - what are they and how are they different?. 1.

Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. QMB coverage is not retroactive.

The program’s benefits will begin the month after the month in which your client is found eligible. ** See special rules about cost-sharing for QMBs below - updated with new CMS directive issued January 2012 ** See NYC HRA QMB Recertification form ** Even if you do not have Part A automatically, because you did not have enough wages, you may be able to enroll in the Part A Buy-In Program, in which people eligible for QMB who do not otherwise have Medicare Part A may enroll, with Medicaid paying the Part A premium (Materials by the Medicare Rights Center). 2. Specifiedl Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only.

SLMB is retroactive, however, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. 3. Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, and not receiving Medicaid, the QI-1 program will cover Medicare Part B premiums only. QI-1 is also retroactive, providing coverage for three months prior to the month of application, as long as your client was eligible during those months.

However, QI-1 retroactive coverage can only be provided within the current calendar year. (GIS 07 MA 027) So if you apply in January, you get no retroactive coverage. Q-I-1 recipients would be eligible for Medicaid with a spend-down, but if they want the Part B premium paid, they must choose between enrolling in QI-1 or Medicaid. They cannot be in both. It is their choice.

DOH MRG p. 19. In contrast, one may receive Medicaid and either QMB or SLIMB. 4. Four Special Benefits of MSPs (in addition to NO ASSET TEST).

Benefit 1. Back Door to Medicare Part D "Extra Help" or Low Income Subsidy -- All MSP recipients are automatically enrolled in Extra Help, the subsidy that makes Part D affordable. They have no Part D deductible or doughnut hole, the premium is subsidized, and they pay very low copayments. Once they are enrolled in Extra Help by virtue of enrollment in an MSP, they retain Extra Help for the entire calendar year, even if they lose MSP eligibility during that year. The "Full" Extra Help subsidy has the same income limit as QI-1 - 135% FPL.

However, many people may be eligible for QI-1 but not Extra Help because QI-1 and the other MSPs have no asset limit. People applying to the Social Security Administration for Extra Help might be rejected for this reason. Recent (2009-10) changes to federal law called "MIPPA" requires the Social Security Administration (SSA) to share eligibility data with NYSDOH on all persons who apply for Extra Help/ the Low Income Subsidy. Data sent to NYSDOH from SSA will enable NYSDOH to open MSP cases on many clients. The effective date of the MSP application must be the same date as the Extra Help application.

Signatures will not be required from clients. In cases where the SSA data is incomplete, NYSDOH will forward what is collected to the local district for completion of an MSP application. The State implementing procedures are in DOH 2010 ADM-03. Also see CMS "Dear State Medicaid Director" letter dated Feb. 18, 2010 Benefit 2.

MSPs Automatically Waive Late Enrollment Penalties for Part B Generally one must enroll in Part B within the strict enrollment periods after turning age 65 or after 24 months of Social Security Disability. An exception is if you or your spouse are still working and insured under an employer sponsored group health plan, or if you have End Stage Renal Disease, and other factors, see this from Medicare Rights Center. If you fail to enroll within those short periods, you might have to pay higher Part B premiums for life as a Late Enrollment Penalty (LEP). Also, you may only enroll in Part B during the Annual Enrollment Period from January 1 - March 31st each year, with Part B not effective until the following July. Enrollment in an MSP automatically eliminates such penalties...

For life.. Even if one later ceases to be eligible for the MSP. AND enrolling in an MSP will automatically result in becoming enrolled in Part B if you didn't already have it and only had Part A. See Medicare Rights Center flyer. Benefit 3.

No Medicaid Lien on Estate to Recover MSP Benefits Paid Generally speaking, states may place liens on the Estates of deceased Medicaid recipients to recover the cost of Medicaid services that were provided after the recipient reached the age of 55. Since 2002, states have not been allowed to recover the cost of Medicare premiums paid under MSPs. In 2010, Congress expanded protection for MSP benefits. Beginning on January 1, 2010, states may not place liens on the Estates of Medicaid recipients who died after January 1, 2010 to recover costs for co-insurance paid under the QMB MSP program for services rendered after January 1, 2010. The federal government made this change in order to eliminate barriers to enrollment in MSPs.

See NYS DOH GIS 10-MA-008 - Medicare Savings Program Changes in Estate Recovery The GIS clarifies that a client who receives both QMB and full Medicaid is exempt from estate recovery for these Medicare cost-sharing expenses. Benefit 4. SNAP (Food Stamp) benefits not reduced despite increased income from MSP - at least temporarily Many people receive both SNAP (Food Stamp) benefits and MSP. Income for purposes of SNAP/Food Stamps is reduced by a deduction for medical expenses, which includes payment of the Part B premium. Since approval for an MSP means that the client no longer pays for the Part B premium, his/her SNAP/Food Stamps income goes up, so their SNAP/Food Stamps go down.

Here are some protections. Do these individuals have to report to their SNAP worker that their out of pocket medical costs have decreased?. And will the household see a reduction in their SNAP benefits, since the decrease in medical expenses will increase their countable income?. The good news is that MSP households do NOT have to report the decrease in their medical expenses to the SNAP/Food Stamp office until their next SNAP/Food Stamp recertification. Even if they do report the change, or the local district finds out because the same worker is handling both the MSP and SNAP case, there should be no reduction in the household’s benefit until the next recertification.

New York’s SNAP policy per administrative directive 02 ADM-07 is to “freeze” the deduction for medical expenses between certification periods. Increases in medical expenses can be budgeted at the household’s request, but NYS never decreases a household’s medical expense deduction until the next recertification. Most elderly and disabled households have 24-month SNAP certification periods. Eventually, though, the decrease in medical expenses will need to be reported when the household recertifies for SNAP, and the household should expect to see a decrease in their monthly SNAP benefit. It is really important to stress that the loss in SNAP benefits is NOT dollar for dollar.

A $100 decrease in out of pocket medical expenses would translate roughly into a $30 drop in SNAP benefits. See more info on SNAP/Food Stamp benefits by the Empire Justice Center, and on the State OTDA website. Some clients will be automatically enrolled in an MSP by the New York State Department of Health (NYSDOH) shortly after attaining eligibility for Medicare. Others need to apply. The 2010 "MIPPA" law introduced some improvements to increase MSP enrollment.

See 3rd bullet below. Also, some people who had Medicaid through the Affordable Care Act before they became eligible for Medicare have special procedures to have their Part B premium paid before they enroll in an MSP. See below. WHO IS AUTOMATICALLY ENROLLED IN AN MSP. Clients receiving even $1.00 of Supplemental Security Income should be automatically enrolled into a Medicare Savings Program (most often QMB) under New York State’s Medicare Savings Program Buy-in Agreement with the federal government once they become eligible for Medicare.

They should receive Medicare Parts A and B. Clients who are already eligible for Medicare when they apply for Medicaid should be automatically assessed for MSP eligibility when they apply for Medicaid. (NYS DOH 2000-ADM-7 and GIS 05 MA 033). Clients who apply to the Social Security Administration for Extra Help, but are rejected, should be contacted &. Enrolled into an MSP by the Medicaid program directly under new MIPPA procedures that require data sharing.

Strategy TIP. Since the Extra Help filing date will be assigned to the MSP application, it may help the client to apply online for Extra Help with the SSA, even knowing that this application will be rejected because of excess assets or other reason. SSA processes these requests quickly, and it will be routed to the State for MSP processing. Since MSP applications take a while, at least the filing date will be retroactive. Note.

The above strategy does not work as well for QMB, because the effective date of QMB is the month after the month of application. As a result, the retroactive effective date of Extra Help will be the month after the failed Extra Help application for those with QMB rather than SLMB/QI-1. APPLYING FOR MSP DIRECTLY WITH LOCAL MEDICAID OFFICE Client already has Medicaid with Local District/HRA but not MSP. They should NOT have to submit an MSP application because the local district is required to review all Medicaid recipients for MSP eligibility and enroll them. (NYS DOH 2000-ADM-7 and GIS 05 MA 033).

But if a Medicaid recipient does not have MSP, contact the Local Medicaid office and request that they be enrolled. In NYC - Use Form 751W and check the box on page 2 requesting evaluation for Medicare Savings Program. Fax it to the Undercare Division at 1-917-639-0837 or email it to undercareproviderrelations@hra.nyc.gov. Use by secure email. If enrolling in the MSP will cause a Spenddown (because income will increase by the amount of the Part B premium, include a completed and signed "Choice Notice" (MAP-3054a)(3/19/2019)(You must adapt this notice - generally check box 3B on page 2 to select enrollment in MSP while keeping Medicaid.) If do not have Medicaid -- must apply for an MSP through their local social services district.

(See more in Section D. Below re those who already have Medicaid through the Affordable Care Act before they became eligible for Medicare. If you are applying for MSP only (not also Medicaid), you can use the simplified MSP application form (theDOH-4328(Rev. 8/2017-- English) (2017 Spanish version not yet available). Either application form can be mailed in -- there is no interview requirement anymore for MSP or Medicaid.

See 10 ADM-04. Applicants will need to submit proof of income, a copy of their Medicare card (front &. Back), and proof of residency/address. See the application form for other instructions. One who is only eligible for QI-1 because of higher income may ONLY apply for an MSP, not for Medicaid too.

One may not receive Medicaid and QI-1 at the same time. If someone only eligible for QI-1 wants Medicaid, s/he may enroll in and deposit excess income into a pooled Supplemental Needs Trust, to bring her countable income down to the Medicaid level, which also qualifies him or her for SLIMB or QMB instead of QI-1. Advocates in NYC can sign up for a half-day "Deputization Training" conducted by the Medicare Rights Center, at which you'll be trained and authorized to complete an MSP application and to submit it via the Medicare Rights Center, which submits it to HRA without the client having to apply in person. Enrolling in an MSP if you already have Medicaid, but just become eligible for Medicare" The procedure for getting the Part B premium paid is different for those whose Medicaid was administered by the NYS of Health Exchange (Marketplace), as opposed to their local social services district. The procedure is also different for those who obtain Medicare because they turn 65, as opposed to obtaining Medicare based on disability.

Either way, Medicaid recipients who transition onto Medicare should be automatically evaluated for MSP eligibility at their next Medicaid recertification. NYS DOH 2000-ADM-7 Individuals can also affirmatively ask to be enrolled in MSP in between recertification periods. Individuals who are eligible for Medicaid with a spenddown can opt whether or not to receive MSP. (Medicaid Reference Guide (MRG) p. 19).

Obtaining MSP may increase their spenddown. IF CLIENT HAD MEDICAID ON THE MARKETPLACE (NYS of Health Exchange) before obtaining Medicare - See article about the Medicare Insurance Payment Program (MIPP). IF CLIENT HAD MEDICAID THROUGH LOCAL DISTRICT - see here, same procedure for any Medicaid recipient who needs MSP. MIPPA - Under MIPPA, the SSA sends a form letter to people who may be eligible for a Medicare Savings Program or Extra Help (Low Income Subsidy - LIS) that they may apply. The letters are.

· Beneficiary has Extra Help (LIS), but not MSP · Beneficiary has no Extra Help (LIS) or MSP 6. Enrolling in MSP for People Age 65+ who do Not have Free Medicare Part A - the "Part A Buy-In Program" Seniors WITHOUT MEDICARE PART A or B -- They may be able to enroll in the Part A Buy-In program, in which people eligible for QMB who are age 65+ who do not otherwise have Medicare Part A may enroll in Part A, with Medicaid paying the Part A premium. See Step-by-Step Guide by the Medicare Rights Center). This guide explains the various steps in "conditionally enrolling" in Part A at the SSA office, which must be done before applying for QMB at the Medicaid office, which will then pay the Part A premium. See also GIS 04 MA/013.

In June, 2018, the SSA revised the POMS manual procedures for the Part A Buy-In to to address inconsistencies and confusion in SSA field offices and help smooth the path for QMB enrollment. The procedures are in the POMS Section HI 00801.140 "Premium-Free Part A Enrollments for Qualified Medicare BenefiIaries." It includes important clarifications, such as. SSA Field Offices should explain the QMB program and conditional enrollment process if an individual lacks premium-free Part A and appears to meet QMB requirements. SSA field offices can add notes to the “Remarks” section of the application and provide a screen shot to the individual so the individual can provide proof of conditional Part A enrollment when applying for QMB through the state Medicaid program. Beneficiaries are allowed to complete the conditional application even if they owe Medicare premiums.

In Part A Buy-in states like NYS, SSA should process conditional applications on a rolling basis (without regard to enrollment periods), even if the application coincides with the General Enrollment Period. (The General Enrollment Period is from Jan 1 to March 31st every year, in which anyone eligible may enroll in Medicare Part A or Part B to be effective on July 1st). 7. What happens after the MSP approval - How is Part B premium paid For all three MSP programs, the Medicaid program is now responsible for paying the Part B premiums, even though the MSP enrollee is not necessarily a recipient of Medicaid. The local Medicaid office (DSS/HRA) transmits the MSP approval to the NYS Department of Health – that information gets shared w/ SSA and CMS SSA stops deducting the Part B premiums out of the beneficiary’s Social Security check.

SSA also refunds any amounts owed to the recipient. (Note. This process can take awhile!. !. !.

) CMS “deems” the MSP recipient eligible for Part D Extra Help/ Low Income Subsidy (LIS). ​Can the MSP be retroactive like Medicaid, back to 3 months before the application?. ​The answer is different for the 3 MSP programs. QMB -No Retroactive Eligibility – Benefits begin the month after the month of the MSP application. 18 NYCRR § 360-7.8(b)(5) SLIMB - YES - Retroactive Eligibility up to 3 months before the application, if was eligible This means applicant may be reimbursed for the 3 months of Part B benefits prior to the month of application.

Parent/Caretaker Relatives levitra canada for sale with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in levitra canada for sale either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL.

If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP. (See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid levitra canada for sale case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP.

However, the transition time can vary based on age. AGE 65+ Those who enroll in Medicare at age 65+ will receive a letter from levitra canada for sale their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02. The Medicaid case takes about four months to be rebudgeted and approved by the LDSS.

The consumer is entitled to MIPP payments for at least levitra canada for sale three months during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP, even if the LDSS determines the consumer is not eligible for Medicaid because of excess income or assets. 08 OHIP/ADM-4. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH levitra canada for sale for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd.

4(c). These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS. NOTE during erectile dysfunction treatment emergency their case may remain with NYSoH levitra canada for sale for more than 12 months. See here.

EXAMPLE. Sam, age levitra canada for sale 60, was last authorized for Medicaid on the Marketplace in June 2020. He became enrolled in Medicare based on disability in August 2020, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2020.

Sam has to pay for his Part B premium - it is deducted from his Social Security check levitra canada for sale. He may call the Marketplace and request a refund. This will continue until the end of his 12 months of continuous MAGI Medicaid eligibility. He will be reimbursed regardless of whether he levitra canada for sale is in a Medicaid managed care plan.

See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. That directive also clarified that reimbursement of the Part B levitra canada for sale premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan. Note.

During the erectile dysfunction treatment emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same MAGI budgeting and automatically levitra canada for sale receive MIPP payments. See GIS 20 MA/04 or this article on erectile dysfunction treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC).

Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the levitra canada for sale amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this levitra canada for sale article.

Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums. See page 96 levitra canada for sale of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP.

If higher than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11 levitra canada for sale. Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &.

1619B. 5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021).

They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019. Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check.

In contrast, MSP enrollees are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as.

A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &.

Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment. Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777.

Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP. If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS. See more here about consumers who have Medicaid on NYSofHealth who then enroll in Medicare - how they access MIPP.

Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing.

See attached sample for what to look for. Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualify enrollees for the "Extra Help" subsidy for Part D prescription drugs. There are three separate MSP programs, the Qualified Medicare Beneficiary (QMB) Program, the Specified Low Income Medicare Beneficiary (SLMB) Program and the Qualified Individual (QI) Program, each of which is discussed below. Those in QMB receive additional subsidies for Medicare costs.

See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH State law. N.Y. Soc. Serv.

L. § 367-a(3)(a), (b), and (d). 2020 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric Hausman, sponsored by NYS Office of the Aging Note. Some consumers may be eligible for the Medicare Insurance Premium Payment (MIPP) Program, instead of MSP.

See this article for more info. TOPICS COVERED IN THIS ARTICLE 1. No Asset Limit 1A. Summary Chart of MSP Programs 2.

Income Limits &. Rules and Household Size 3. The Three MSP Programs - What are they and how are they Different?. 4.

FOUR Special Benefits of MSP Programs. Back Door to Extra Help with Part D MSPs Automatically Waive Late Enrollment Penalties for Part B - and allow enrollment in Part B year-round outside of the short Annual Enrollment Period No Medicaid Lien on Estate to Recover Payment of Expenses Paid by MSP Food Stamps/SNAP not reduced by Decreased Medical Expenses when Enroll in MSP - at least temporarily 5. Enrolling in an MSP - Automatic Enrollment &. Applications for People who Have Medicare WHO IS AUTOMATICALLY ENROLLED IN AN MSP Applying for MSP Directly with Local Medicaid Program - including those who already have Medicaid through local Medicaid program but need MSP, and those newly applying for MSP Enrolling in an MSP if you have Medicaid and Just Became Eligible for Medicare MIPPA - SSA Notifies Social Security recipients that they may be eligible for MSP based on their income.

6. Enrolling in an MSP for People age 65+ who Do Not Qualify for Free Medicare Part A - the "Part A Buy-In Program" 7. What Happens After MSP Approved - How Part B Premium is Paid 8 Special Rules for QMBs - How Medicare Cost-Sharing Works 1. NO ASSET LIMIT!.

Since April 1, 2008, none of the three MSP programs have resource limits in New York -- which means many Medicare beneficiaries who might not qualify for Medicaid because of excess resources can qualify for an MSP. 1.A. SUMMARY CHART OF MSP BENEFITS QMB SLIMB QI-1 Eligibility ASSET LIMIT NO LIMIT IN NEW YORK STATE INCOME LIMIT (2021) Single Couple Single Couple Single Couple $1,094 $1,472 $1,308 $1,762 $1,469 $1,980 Federal Poverty Level 100% FPL 100 – 120% FPL 120 – 135% FPL Benefits Pays Monthly Part B premium?. YES, and also Part A premium if did not have enough work quarters and meets citizenship requirement.

See “Part A Buy-In” YES YES Pays Part A &. B deductibles &. Co-insurance YES - with limitations NO NO Retroactive to Filing of Application?. Yes - Benefits begin the month after the month of the MSP application.

18 NYCRR §360-7.8(b)(5) Yes – Retroactive to 3rd month before month of application, if eligible in prior months Yes – may be retroactive to 3rd month before month of applica-tion, but only within the current calendar year. (No retro for January application). See GIS 07 MA 027. Can Enroll in MSP and Medicaid at Same Time?.

YES YES NO!. Must choose between QI-1 and Medicaid. Cannot have both, not even Medicaid with a spend-down. 2.

INCOME LIMITS and RULES Each of the three MSP programs has different income eligibility requirements and provides different benefits. The income limits are tied to the Federal Poverty Level (FPL). 2021 FPL levels were released by NYS DOH in GIS 21 MA/06 - 2021 Federal Poverty Levels Attachment II NOTE. There is usually a lag in time of several weeks, or even months, from January 1st of each year until the new FPLs are release, and then before the new MSP income limits are officially implemented.

During this lag period, local Medicaid offices should continue to use the previous year's FPLs AND count the person's Social Security benefit amount from the previous year - do NOT factor in the Social Security COLA (cost of living adjustment). Once the updated guidelines are released, districts will use the new FPLs and go ahead and factor in any COLA. See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH Income is determined by the same methodology as is used for determining in eligibility for SSI The rules for counting income for SSI-related (Aged 65+, Blind, or Disabled) Medicaid recipients, borrowed from the SSI program, apply to the MSP program, except for the new rules about counting household size for married couples. N.Y.

Soc. Serv. L. 367-a(3)(c)(2), NYS DOH 2000-ADM-7, 89-ADM-7 p.7.

Gross income is counted, although there are certain types of income that are disregarded. The most common income disregards, also known as deductions, include. (a) The first $20 of your &. Your spouse's monthly income, earned or unearned ($20 per couple max).

(b) SSI EARNED INCOME DISREGARDS. * The first $65 of monthly wages of you and your spouse, * One-half of the remaining monthly wages (after the $65 is deducted). * Other work incentives including PASS plans, impairment related work expenses (IRWEs), blind work expenses, etc. For information on these deductions, see The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) and other guides in this article -- though written for the MBI-WPD, the work incentives apply to all Medicaid programs, including MSP, for people age 65+, disabled or blind.

(c) monthly cost of any health insurance premiums but NOT the Part B premium, since Medicaid will now pay this premium (may deduct Medigap supplemental policies, vision, dental, or long term care insurance premiums, and the Part D premium but only to the extent the premium exceeds the Extra Help benchmark amount) (d) Food stamps not counted. You can get a more comprehensive listing of the SSI-related income disregards on the Medicaid income disregards chart. As for all benefit programs based on financial need, it is usually advantageous to be considered a larger household, because the income limit is higher. The above chart shows that Households of TWO have a higher income limit than households of ONE.

The MSP programs use the same rules as Medicaid does for the Disabled, Aged and Blind (DAB) which are borrowed from the SSI program for Medicaid recipients in the “SSI-related category.” Under these rules, a household can be only ONE or TWO. 18 NYCRR 360-4.2. See DAB Household Size Chart. Married persons can sometimes be ONE or TWO depending on arcane rules, which can force a Medicare beneficiary to be limited to the income limit for ONE person even though his spouse who is under 65 and not disabled has no income, and is supported by the client applying for an MSP.

EXAMPLE. Bob's Social Security is $1300/month. He is age 67 and has Medicare. His wife, Nancy, is age 62 and is not disabled and does not work.

Under the old rule, Bob was not eligible for an MSP because his income was above the Income limit for One, even though it was well under the Couple limit. In 2010, NYS DOH modified its rules so that all married individuals will be considered a household size of TWO. DOH GIS 10 MA 10 Medicare Savings Program Household Size, June 4, 2010. This rule for household size is an exception to the rule applying SSI budgeting rules to the MSP program.

Under these rules, Bob is now eligible for an MSP. When is One Better than Two?. Of course, there may be couples where the non-applying spouse's income is too high, and disqualifies the applying spouse from an MSP. In such cases, "spousal refusal" may be used SSL 366.3(a).

(Link is to NYC HRA form, can be adapted for other counties). In NYC, if you have a Medicaid case with HRA, instead of submitting an MSP application, you only need to complete and submit MAP-751W (check off "Medicare Savings Program Evaluation") and fax to (917) 639-0837. (The MAP-751W is also posted in languages other than English in this link. (Updated 4/14/2021.)) 3.

The Three Medicare Savings Programs - what are they and how are they different?. 1. Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits.

Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. QMB coverage is not retroactive. The program’s benefits will begin the month after the month in which your client is found eligible.

** See special rules about cost-sharing for QMBs below - updated with new CMS directive issued January 2012 ** See NYC HRA QMB Recertification form ** Even if you do not have Part A automatically, because you did not have enough wages, you may be able to enroll in the Part A Buy-In Program, in which people eligible for QMB who do not otherwise have Medicare Part A may enroll, with Medicaid paying the Part A premium (Materials by the Medicare Rights Center). 2. Specifiedl Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only.

SLMB is retroactive, however, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. 3. Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, and not receiving Medicaid, the QI-1 program will cover Medicare Part B premiums only.

QI-1 is also retroactive, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. However, QI-1 retroactive coverage can only be provided within the current calendar year. (GIS 07 MA 027) So if you apply in January, you get no retroactive coverage. Q-I-1 recipients would be eligible for Medicaid with a spend-down, but if they want the Part B premium paid, they must choose between enrolling in QI-1 or Medicaid.

They cannot be in both. It is their choice. DOH MRG p. 19.

In contrast, one may receive Medicaid and either QMB or SLIMB. 4. Four Special Benefits of MSPs (in addition to NO ASSET TEST). Benefit 1.

Back Door to Medicare Part D "Extra Help" or Low Income Subsidy -- All MSP recipients are automatically enrolled in Extra Help, the subsidy that makes Part D affordable. They have no Part D deductible or doughnut hole, the premium is subsidized, and they pay very low copayments. Once they are enrolled in Extra Help by virtue of enrollment in an MSP, they retain Extra Help for the entire calendar year, even if they lose MSP eligibility during that year. The "Full" Extra Help subsidy has the same income limit as QI-1 - 135% FPL.

However, many people may be eligible for QI-1 but not Extra Help because QI-1 and the other MSPs have no asset limit. People applying to the Social Security Administration for Extra Help might be rejected for this reason. Recent (2009-10) changes to federal law called "MIPPA" requires the Social Security Administration (SSA) to share eligibility data with NYSDOH on all persons who apply for Extra Help/ the Low Income Subsidy. Data sent to NYSDOH from SSA will enable NYSDOH to open MSP cases on many clients.

The effective date of the MSP application must be the same date as the Extra Help application. Signatures will not be required from clients. In cases where the SSA data is incomplete, NYSDOH will forward what is collected to the local district for completion of an MSP application. The State implementing procedures are in DOH 2010 ADM-03.

Also see CMS "Dear State Medicaid Director" letter dated Feb. 18, 2010 Benefit 2. MSPs Automatically Waive Late Enrollment Penalties for Part B Generally one must enroll in Part B within the strict enrollment periods after turning age 65 or after 24 months of Social Security Disability. An exception is if you or your spouse are still working and insured under an employer sponsored group health plan, or if you have End Stage Renal Disease, and other factors, see this from Medicare Rights Center.

If you fail to enroll within those short periods, you might have to pay higher Part B premiums for life as a Late Enrollment Penalty (LEP). Also, you may only enroll in Part B during the Annual Enrollment Period from January 1 - March 31st each year, with Part B not effective until the following July. Enrollment in an MSP automatically eliminates such penalties... For life..

Even if one later ceases to be eligible for the MSP. AND enrolling in an MSP will automatically result in becoming enrolled in Part B if you didn't already have it and only had Part A. See Medicare Rights Center flyer. Benefit 3.

No Medicaid Lien on Estate to Recover MSP Benefits Paid Generally speaking, states may place liens on the Estates of deceased Medicaid recipients to recover the cost of Medicaid services that were provided after the recipient reached the age of 55. Since 2002, states have not been allowed to recover the cost of Medicare premiums paid under MSPs. In 2010, Congress expanded protection for MSP benefits. Beginning on January 1, 2010, states may not place liens on the Estates of Medicaid recipients who died after January 1, 2010 to recover costs for co-insurance paid under the QMB MSP program for services rendered after January 1, 2010.

The federal government made this change in order to eliminate barriers to enrollment in MSPs. See NYS DOH GIS 10-MA-008 - Medicare Savings Program Changes in Estate Recovery The GIS clarifies that a client who receives both QMB and full Medicaid is exempt from estate recovery for these Medicare cost-sharing expenses. Benefit 4. SNAP (Food Stamp) benefits not reduced despite increased income from MSP - at least temporarily Many people receive both SNAP (Food Stamp) benefits and MSP.

Income for purposes of SNAP/Food Stamps is reduced by a deduction for medical expenses, which includes payment of the Part B premium. Since approval for an MSP means that the client no longer pays for the Part B premium, his/her SNAP/Food Stamps income goes up, so their SNAP/Food Stamps go down. Here are some protections. Do these individuals have to report to their SNAP worker that their out of pocket medical costs have decreased?.

And will the household see a reduction in their SNAP benefits, since the decrease in medical expenses will increase their countable income?. The good news is that MSP households do NOT have to report the decrease in their medical expenses to the SNAP/Food Stamp office until their next SNAP/Food Stamp recertification. Even if they do report the change, or the local district finds out because the same worker is handling both the MSP and SNAP case, there should be no reduction in the household’s benefit until the next recertification. New York’s SNAP policy per administrative directive 02 ADM-07 is to “freeze” the deduction for medical expenses between certification periods.

Increases in medical expenses can be budgeted at the household’s request, but NYS never decreases a household’s medical expense deduction until the next recertification. Most elderly and disabled households have 24-month SNAP certification periods. Eventually, though, the decrease in medical expenses will need to be reported when the household recertifies for SNAP, and the household should expect to see a decrease in their monthly SNAP benefit. It is really important to stress that the loss in SNAP benefits is NOT dollar for dollar.

A $100 decrease in out of pocket medical expenses would translate roughly into a $30 drop in SNAP benefits. See more info on SNAP/Food Stamp benefits by the Empire Justice Center, and on the State OTDA website. Some clients will be automatically enrolled in an MSP by the New York State Department of Health (NYSDOH) shortly after attaining eligibility for Medicare. Others need to apply.

The 2010 "MIPPA" law introduced some improvements to increase MSP enrollment. See 3rd bullet below. Also, some people who had Medicaid through the Affordable Care Act before they became eligible for Medicare have special procedures to have their Part B premium paid before they enroll in an MSP. See below.

WHO IS AUTOMATICALLY ENROLLED IN AN MSP. Clients receiving even $1.00 of Supplemental Security Income should be automatically enrolled into a Medicare Savings Program (most often QMB) under New York State’s Medicare Savings Program Buy-in Agreement with the federal government once they become eligible for Medicare. They should receive Medicare Parts A and B. Clients who are already eligible for Medicare when they apply for Medicaid should be automatically assessed for MSP eligibility when they apply for Medicaid.

(NYS DOH 2000-ADM-7 and GIS 05 MA 033). Clients who apply to the Social Security Administration for Extra Help, but are rejected, should be contacted &. Enrolled into an MSP by the Medicaid program directly under new MIPPA procedures that require data sharing. Strategy TIP.

Since the Extra Help filing date will be assigned to the MSP application, it may help the client to apply online for Extra Help with the SSA, even knowing that this application will be rejected because of excess assets or other reason. SSA processes these requests quickly, and it will be routed to the State for MSP processing. Since MSP applications take a while, at least the filing date will be retroactive. Note.

The above strategy does not work as well for QMB, because the effective date of QMB is the month after the month of application. As a result, the retroactive effective date of Extra Help will be the month after the failed Extra Help application for those with QMB rather than SLMB/QI-1. APPLYING FOR MSP DIRECTLY WITH LOCAL MEDICAID OFFICE Client already has Medicaid with Local District/HRA but not MSP. They should NOT have to submit an MSP application because the local district is required to review all Medicaid recipients for MSP eligibility and enroll them.

(NYS DOH 2000-ADM-7 and GIS 05 MA 033). But if a Medicaid recipient does not have MSP, contact the Local Medicaid office and request that they be enrolled. In NYC - Use Form 751W and check the box on page 2 requesting evaluation for Medicare Savings Program. Fax it to the Undercare Division at 1-917-639-0837 or email it to undercareproviderrelations@hra.nyc.gov.

Use by secure email. If enrolling in the MSP will cause a Spenddown (because income will increase by the amount of the Part B premium, include a completed and signed "Choice Notice" (MAP-3054a)(3/19/2019)(You must adapt this notice - generally check box 3B on page 2 to select enrollment in MSP while keeping Medicaid.) If do not have Medicaid -- must apply for an MSP through their local social services district. (See more in Section D. Below re those who already have Medicaid through the Affordable Care Act before they became eligible for Medicare.

If you are applying for MSP only (not also Medicaid), you can use the simplified MSP application form (theDOH-4328(Rev. 8/2017-- English) (2017 Spanish version not yet available). Either application form can be mailed in -- there is no interview requirement anymore for MSP or Medicaid. See 10 ADM-04.

Applicants will need to submit proof of income, a copy of their Medicare card (front &. Back), and proof of residency/address. See the application form for other instructions. One who is only eligible for QI-1 because of higher income may ONLY apply for an MSP, not for Medicaid too.

One may not receive Medicaid and QI-1 at the same time. If someone only eligible for QI-1 wants Medicaid, s/he may enroll in and deposit excess income into a pooled Supplemental Needs Trust, to bring her countable income down to the Medicaid level, which also qualifies him or her for SLIMB or QMB instead of QI-1. Advocates in NYC can sign up for a half-day "Deputization Training" conducted by the Medicare Rights Center, at which you'll be trained and authorized to complete an MSP application and to submit it via the Medicare Rights Center, which submits it to HRA without the client having to apply in person. Enrolling in an MSP if you already have Medicaid, but just become eligible for Medicare" The procedure for getting the Part B premium paid is different for those whose Medicaid was administered by the NYS of Health Exchange (Marketplace), as opposed to their local social services district.

The procedure is also different for those who obtain Medicare because they turn 65, as opposed to obtaining Medicare based on disability. Either way, Medicaid recipients who transition onto Medicare should be automatically evaluated for MSP eligibility at their next Medicaid recertification. NYS DOH 2000-ADM-7 Individuals can also affirmatively ask to be enrolled in MSP in between recertification periods. Individuals who are eligible for Medicaid with a spenddown can opt whether or not to receive MSP.

(Medicaid Reference Guide (MRG) p. 19). Obtaining MSP may increase their spenddown. IF CLIENT HAD MEDICAID ON THE MARKETPLACE (NYS of Health Exchange) before obtaining Medicare - See article about the Medicare Insurance Payment Program (MIPP).

IF CLIENT HAD MEDICAID THROUGH LOCAL DISTRICT - see here, same procedure for any Medicaid recipient who needs MSP. MIPPA - Under MIPPA, the SSA sends a form letter to people who may be eligible for a Medicare Savings Program or Extra Help (Low Income Subsidy - LIS) that they may apply. The letters are. · Beneficiary has Extra Help (LIS), but not MSP · Beneficiary has no Extra Help (LIS) or MSP 6.

Enrolling in MSP for People Age 65+ who do Not have Free Medicare Part A - the "Part A Buy-In Program" Seniors WITHOUT MEDICARE PART A or B -- They may be able to enroll in the Part A Buy-In program, in which people eligible for QMB who are age 65+ who do not otherwise have Medicare Part A may enroll in Part A, with Medicaid paying the Part A premium. See Step-by-Step Guide by the Medicare Rights Center). This guide explains the various steps in "conditionally enrolling" in Part A at the SSA office, which must be done before applying for QMB at the Medicaid office, which will then pay the Part A premium. See also GIS 04 MA/013.

In June, 2018, the SSA revised the POMS manual procedures for the Part A Buy-In to to address inconsistencies and confusion in SSA field offices and help smooth the path for QMB enrollment. The procedures are in the POMS Section HI 00801.140 "Premium-Free Part A Enrollments for Qualified Medicare BenefiIaries." It includes important clarifications, such as. SSA Field Offices should explain the QMB program and conditional enrollment process if an individual lacks premium-free Part A and appears to meet QMB requirements. SSA field offices can add notes to the “Remarks” section of the application and provide a screen shot to the individual so the individual can provide proof of conditional Part A enrollment when applying for QMB through the state Medicaid program.

Beneficiaries are allowed to complete the conditional application even if they owe Medicare premiums. In Part A Buy-in states like NYS, SSA should process conditional applications on a rolling basis (without regard to enrollment periods), even if the application coincides with the General Enrollment Period. (The General Enrollment Period is from Jan 1 to March 31st every year, in which anyone eligible may enroll in Medicare Part A or Part B to be effective on July 1st). 7.

What happens after the MSP approval - How is Part B premium paid For all three MSP programs, the Medicaid program is now responsible for paying the Part B premiums, even though the MSP enrollee is not necessarily a recipient of Medicaid. The local Medicaid office (DSS/HRA) transmits the MSP approval to the NYS Department of Health – that information gets shared w/ SSA and CMS SSA stops deducting the Part B premiums out of the beneficiary’s Social Security check. SSA also refunds any amounts owed to the recipient. (Note.

This process can take awhile!. !. !. ) CMS “deems” the MSP recipient eligible for Part D Extra Help/ Low Income Subsidy (LIS).

​Can the MSP be retroactive like Medicaid, back to 3 months before the application?. ​The answer is different for the 3 MSP programs. QMB -No Retroactive Eligibility – Benefits begin the month after the month of the MSP application. 18 NYCRR § 360-7.8(b)(5) SLIMB - YES - Retroactive Eligibility up to 3 months before the application, if was eligible This means applicant may be reimbursed for the 3 months of Part B benefits prior to the month of application.

QI-1 - YES up to 3 months but only in the same calendar year. No retroactive eligibility to the previous year. 7. QMBs -Special Rules on Cost-Sharing.

QMB is the only MSP program which pays not only the Part B premium, but also the Medicare co-insurance. However, there are limitations. First, co-insurance will only be paid if the provide accepts Medicaid. Not all Medicare provides accept Medicaid.

Second, under recent changes in New York law, Medicaid will not always pay the Medicare co-insurance, even to a Medicaid provider.

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H. The Chair of the National Council on Disability.

Application submissions levitra canada for sale will be http://tkssecurity.com/buy-diflucan-cheap-online/ accepted for 30 calendar days from the date this posting is published in the Federal Register. Application Period. The application submissions will be accepted for 30 calendar days from the date this posting is published in the Federal Register. Start Further Info Maxine Kellman, DVM, Ph.D., PMP, Alternate Designated Federal Official for levitra canada for sale National Advisory Committees, Washington, DC, Office (202) 260-0447 or email maxine.kellman@hhs.gov.

End Further Info End Preamble Start Supplemental Information The Office of the Assistant Secretary for Preparedness and Response provides management and administrative oversight to support the activities of the NACIDD. Description of Duties. The NACIDD shall evaluate levitra canada for sale issues and programs and provide findings, advice, and recommendations to the Secretary of HHS, in accordance with FACA, to support and enhance all-hazards public health and medical preparedness, response activities, and recovery aimed at meeting the unique needs of individuals with disabilities across the entire spectrum of their wellbeing. The NACIDD shall (1) provide advice and consultation with respect to activities carried out pursuant to section 2814 of the PHS Act (at-risk individuals), as applicable and appropriate.

(2) evaluate and provide input with respect to the medical, public health, and accessibility needs of individuals with disabilities related to preparation for, response to, and recovery from all-hazards emergencies. And (3) provide advice and levitra canada for sale consultation with respect to State emergency preparedness and response activities, including related drills and exercises pursuant to the preparedness Start Printed Page 26227goals under section 2802(b) of the PHS Act (National Health Security Strategy). The NACIDD will primarily, though not exclusively. A.

Monitor for and provide advice regarding emerging policy, scientific, technical, or operational issues and levitra canada for sale concerns related to medical and public health preparedness, response, and recovery in the event of a public health emergency declared by the Secretary of HHS. B. Evaluate and provide advice on implementation of the preparedness goals described in the National Health Security Strategy as they apply to individuals with disabilities. C.

Monitor and make recommendations to improve HHS assistance to other Departments in planning for, responding to, and recovering from public health emergencies with respect to the effects on individuals with disabilities and their families. D. Make recommendations to ensure that the contents of the Strategic National Stockpile take into account the unique needs of individuals with disabilities. E.

Make recommendations regarding curriculum development for public health and medical response training for medical management of casualties among individuals with disabilities. F. Monitor and provide advice regarding novel and best practices of outreach to, and care of, individuals with disabilities before, during, and following public health emergencies. G.

Monitor and make recommendations to ensure that public health and medical information distributed by HHS during a public health emergency is delivered in a manner that takes into account the range of developmentally appropriate communication needs of individuals with disabilities and their families or guardians. H. Provide advice for coordination of systems for situational awareness and biosurveillance that require incorporation of data and information from Federal, State, local, Tribal, and Territorial public health officials and relevant entities to identify health threats to individuals with disabilities and families. I.

Evaluate and provide inputs with respect to the medical, mental and behavioral, and public health needs of individuals with disabilities as they relate to preparation for, response to, and recovery from all-hazards emergencies. J. Provide advice and consultation with respect to individuals with disabilities and State, Tribal, and Territorial emergency preparedness and response activities, including related drills and exercises pursuant to the preparedness goals in the National Health Security Strategy. Structure.

Members shall be appointed by the HHS Secretary from among the nation's preeminent scientific, public health, and medical experts in areas consistent with the purpose and functions of the advisory committee. The HHS Secretary, in consultation with such other heads of federal agencies as may be appropriate, shall appoint a maximum of 17 members to the NACIDD, ensuring that the total membership is an odd number. The NACIDD shall consist of at least seven non-federal voting members, including a Chairperson, including. (A) At least two non-federal health care professionals with expertise in disability accessibility before, during, and after disasters, medical and mass care disaster planning, preparedness, response, or recovery.

(B) At least two representatives from State, local, Tribal, or territorial agencies with expertise in disaster planning, preparedness, response, or recovery for individuals with disabilities. And (C) At least two individuals with a disability with expertise in disaster planning, preparedness, response, or recovery for individuals with disabilities. The NACIDD shall also have up to 10 federal, non-voting ex officio members including the following officials or their designees. A.

The Assistant Secretary for Preparedness and Response. B. The Administrator for the Administration for Community Living. C.

The Director of the Biomedical Advanced Research and Development Authority. D. The Director of the Centers for Disease Control and Prevention. E.

The Commissioner of Food and Drugs. F. The Director of the National Institutes of Health. G.

The Administrator of the Federal Emergency Management Agency. H. The Chair of the National Council on Disability. I.

The Chair of the United States Access Board. J. The Under Secretary for Health of the Department of Veterans Affairs.