The Affordable Care Act expanded the Part D Extra Help Program, also known as the Low-Income Subsidy (LIS), so that dual eligibles enrolled in certain Medi-Cal Home and Community-Based Services (HCBS) should not be charged any co-pays for Part D covered drugs. However, between 2012 and 2020, California’s dual eligibles enrolled in Community-Based Adult Services (CBAS) and in San Mateo’s Multipurpose Senior Services Program (MSSP) were improperly charged co-pays.  

Last year, the Centers for Medicare & Medicaid Services (CMS) and California’s Department of Health Care Services (DHCS) worked together with Part D and Medicare Advantage plans so that these dual eligibles are properly assessed co-pays, and began to process retroactive reimbursements for improper amounts collected. In order to fully reimburse these dual eligibles, Part D and Medicare Advantage plans are expected to issue final refunds by January 18, 2021, to an estimated 45,000 individuals for improper amounts collected between 2012 and 2017. As with previous refunds, these amounts will not count toward eligibility for government benefits programs.  

Justice in Aging created an FAQ for advocates to answer key questions about the refunds. We also presented a webinar on the topic last year. You can access the recording and the slides here.  

Read the FAQ.

Share This

Contact Us

Justice in Aging
(202) 289-6976

View as webpage