FAQ: Part D Drug Co-Pays and Refunds for Certain California Dual Eligibles

In 2012, 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 Home and Community-Based Services (HCBS) should not be charged any co-pays for Part D covered drugs. However, since 2012, some California duals enrolled in Community-Based Adult Services (CBAS) and in San Mateo’s Multipurpose Senior Services Programs (MSSP) have been improperly charged co-pays. The Centers for Medicare & Medicaid Services (CMS) and California’s Department of Health Care Services (DHCS) is beginning to work with Part D and Medicare Advantage plans so that these dual eligibles are properly assessed co-pays and retroactively reimbursed for any improper amounts collected.

Justice in Aging created an FAQ for advocates to answer key questions about the implementation of these refunds.

Katrina Cohens

About Katrina Cohens

Katrina Cohens is based in Justice in Aging’s Washington, DC office and serves as the Database Manager.