LIS – Low Income Supplement (Medicaid)

VLSSE Financial Services Committee Position Paper

January 26, 2012

Presenting Problem:

The LIS (Low Income Supplement – Medicaid) process was new work that came to local agencies without any preparation. Our understanding is that this is a process required by Social Security. The program takes valuable administrative time in local agencies that are severely understaffed and has added copying and mailing costs. Our experience is that it is a failed program and process.

Process:

Whenever a person asks for “Extra Help” at Social Security, a LIS-Medicaid application is sent electronically to VDSS. For some unknown reason, these are batched and come to the LDSS two to three months after the application is made. Agencies often get big batches on one day. The application date is the date it is received by LDSS, not the date it was received by SSA or VDSS. No one is accountable until it comes to us. Once the LDSS receives the application, we are required to give the applicant 10 working days to respond. All other programs are 10 calendar days and this difference can cause a delay in meeting the 30 day processing time frame. This happens when the person returns the application and then needs to provide additional information and is given another ten days to return the information.

Concerns:

•Most LIS applicants have no idea that their application for Extra Help is also a LIS-Medicaid application. When LDSS sends a letter, some customers call very upset that we have their Social Security number. Some have even accused us of identity theft.

•Very few LIS applications are actually returned. We do not have exact numbers, but estimate that only about 1 in 10 applicants return the form. Most of those are denied. This process is this labor intensive and yields such a low approval rate that it is ineffective.

•The application form that comes from SSA is always incomplete. The income information often has the annual income as the monthly income.

•This process represents a major administrative workload. Someone has to pull the applications off the system, print them, and send a letter and the pre-filled LIS- Medicaid application to the applicant.

•Also, the letter apparently tells applicants to not provide any information to DSS until they have received an official checklist. One customer was denied because he didn’t provide verifications waiting for this. The worker didn’t know about the requirement.

•The application is usually 14 pages. This has to be printed locally and mailed by the LDSS, which is an additional administrative expense for the locality.

•There is no screening process to determine if the applicant might be Medicaid eligible. All applications come to DSS. Extra Help is an online application process, could SSA add some screening questions in their system?

•Many applications go to the wrong locality.

•Because these applications can easily be processed late, due to the 10 work day requirement and the confusion caused by the application process, local processing time goals are seeing a decline in performance. LDSS is required to process these applications within the same time frames as other applications. The LIS applications are often delayed in reaching us for several months, which indicates these are not as urgent.

•The biggest concern for LDSS is that this ineffective, inefficient system takes staff away from the applications for families and individuals who have actually applied for and need Medicaid or other benefits. Localities are struggling to meet the demands of large caseloads and to meet the important goals of timely processing and timely renewals. This takes staff time away from those goals.

Recommendations:

  1. Our state staff advocate on our behalf by asking their Federal partners to review this process and reduce the burden on localities.
  2. If the state cannot work with their Federal partners and obtain some relief, we request the state provide administrative support. Localities need the state to mail out the applications and the letters to applicants with instructions on how and where to return the form. Once the completed application is returned to the LDSS, the locality would be responsible for it.