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Extra Help Project

Extra Help (aka LIS) – Eligibility Criteria

1)  Only Screen If Extra Help or MSP Flag Appears

a. Client is age 65 or older.
b. Client’s income is within program limits.
c. Client is not on Medicaid.
d. Client has not been screened for the project.

2)  Is Client on Extra Help Program?

a.  Is Part D monthly premium at least $14.80?

$14.80 is the cheapest available Part D monthly premium:  The Walmart Plan.  If client pays less, she is on Extra Help.

b.  Is prescription co-pay more than $2.55 (generic) or $6.35 (Brand Name)?

If Yes, then not on Extra Help.

3)  Is Client Eligible for Extra Help Program?

Are Income & Assets Within Limits?

150% FPL

Household – Monthly Income – Assets

1 person:        $1,459          $13,440

2 person:        $1,966          $26,860

Extra Help will count the couple’s gross income and assets if spouses are living together or only temporarily living apart.

  • Excluded resources
    1. Homestead & Personal Property
    2. Life insurance
    3. Vehicles
    4. Personal Property
    5. Burial Plots
    6. Irrevocable Funeral Contracts
    7. Lump Sums from SS or SSI
  • Included resources
    1. Other Real Estate
    2. Bank Accounts, Savings Bonds
    3. Stocks, Bonds, CDs
    4. Mutual funds
    5. IRAs

Medicare Savings Programs

MSP eligibility is more restrictive than Extra Help.  Clients already on Extra Help are auto-eligible for MSP but may not be enrolled.  Ask:

  Does client pay her Part B premium ($104.90)?

  Is client on Medicaid or SSI? (If so, auto-enrollment in MSP)

MSPs are three separate programs: QMB (100% FPL), SLMB (120% FPL) & QI-1, which is 135% Poverty Level.  All have the same asset limits.

QI-1 Monthly
Household –     Income –     Assets
1 person:      $1,333        $ 7,160
2 person:      $1,790        $10,750

Generally See:

    ODJFS 7103 MSP Application
ODJFS MSP Fact Sheet
    Pro Seniors MSP Pamphlet
    Dual Eligibles Table
    SSA Extra Help FAQs
    Pro Seniors MSP Cite Sheet
    California MSP Fact Sheet