As of April 2023, California restored 40,810 individuals back to their original Medicare Savings Program (MSP) tier under the preliminary injunction in Carr v. Becerra. The preliminary injunction required all states to stop terminating or reducing Medicaid coverage, including MSPs, during the COVID Public Health Emergency (PHE).
During the PHE, California moved individuals to MSP tiers that provided reduced benefits. Specifically, when individuals were moved from the Qualified Medicare Beneficiary (QMB) tier to the Specified Low-Income Beneficiary (SLMB) or Qualifying Individual (QI) tiers, some people lost coverage for payment of Medicare Part A premiums and may have had to pay Medicare deductibles, co-payments, and co-insurance.
What Advocates Need to Know
- Individuals were reinstated to their original MSP tier retroactive to the date of the original change in their MSP coverage.
- Individuals who paid Part A premiums due to the loss of QMB status will receive a reimbursement from the Social Security Administration. This will happen automatically.
- Individuals who paid Medicare deductibles, co-payments, and co-insurance because they lost QMB status can submit a claim for reimbursement through the Conlan process.
- Reimbursements received as a result of the MSP restoration are not countable as income and will not affect Medi-Cal and/or MSP eligibility.
- Individuals will remain in the restored MSP tier until their Medi-Cal renewal, at which time they will be reassessed for MSP eligibility.
A copy of the outreach notice California sent to affected individuals is available.