2019 LCM-01 - Outreach to Assist Medicaid Recipients with Applying for Medicare

The purpose of this Local Commissioners Memorandum (LCM) is to inform local departments of social services (LDSS) of State-wide outreach efforts to assist consumers in meeting the requirement to apply for Medicare as a condition of Medicaid eligibility, as described in 17 OHIP/ADM-01, "Medicare Enrollment at Age 65."

The Department of Health has contracted with several agencies throughout the State to provide outreach and application assistance to individuals identified by the State, as appearing to meet the criteria of eligibility for Medicare, to ensure an application for Medicare benefits is made. This includes individuals diagnosed with End Stage Renal Disease (ESRD) and recipients turning age 65 within the next three months. Medicaid consumer participation in this assistance is voluntary and provided at no cost to consumers. The agencies performing outreach and application assistance are the same agencies that currently assist the aged, blind and disabled populations in applying for Medicaid. The Facilitated Enrollers (FEs) have been trained to provide assistance to consumers in applying for Medicare.

Each month, the State identifies recipients who will be turning age 65 within the next three months, or, who have been diagnosed with ESRD, and sends a letter informing the individuals about Medicare benefits. The letter advises the individual how to apply for Medicare, that it is a condition of Medicaid eligibility to apply for Medicare, and that the Medicaid program may pay or reimburse the cost of the Medicare premiums.

In August 2018, the Department began to forward the monthly listing of identified individuals to the lead FE agencies. The FEs contact the individuals by phone, using approved scripted language, when a valid phone number is provided, and by mail using an approved postcard (Attachment II) when a phone number is not available or when the individual cannot be reached by phone. Each agency will add their contact information to the postcard.

The FEs will inform recipients of the requirement to apply for Medicare as a condition of maintaining their eligibility for Medicaid, educate them on how and where to apply for Medicare, and assist the individual in applying for Medicare, if requested, and gathering the required verification for Medicaid.

A Standard Protocol (Attachment III) was developed for the work the lead agencies will be performing and the expected interactions with local districts. Proof that a person has applied for Medicare will be provided to the local district using the "Proof of Medicare Application Transmittal & Confirmation Receipt Form" (Attachment IV). Agencies will contact their respective district to determine where this information should be sent, and if there is a specific contact person they should communicate with. The district must complete the form acknowledging receipt of proof of Medicare application and return it to the contact person identified on the form at the lead agency.

Each FE lead agency is required to provide data to the State regarding final outcomes of outreach assistance.

If you have questions regarding any of the information provided in this memorandum or its attachments, please contact your local district Medicaid liaison at (518) 474-8887 for Upstate counties, and (212) 417-4500 for New York City.

Donna Frescatore
Medicaid Director
Office of Health Insurance Programs