MA Referral for Other Benefits

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1. What is the “Medical Assistance (MA) Referral for Other Benefits”?

The Medical Assistance (MA) Referral for Other Benefits is used because MA is the payer of last resort for medical expenses.
If someone can receive coverage or payment for medical costs from another program, they must apply for that program first before MA will pay.

2. Why do I have to apply for other benefits if I already have MA?

You must apply because MA only pays after all other potential benefits have been used. Applying ensures:

• You receive all assistance you’re eligible for.
• You maintain your MA eligibility.

3. Who must apply for other programs?

If you are on MA under the MA-ABD basis (MA for people who are age 65 or older, blind, or disabled) and do not have a Social Security disability certification, you must apply for Social Security benefits—even if you have a SMRT disability certification.
Exception: TEFRA applicants are not required to apply for Social Security disability benefits.

Additionally, if you may be eligible for Medicare, you must apply for Medicare to keep your MA eligibility.

4. When must I apply for other benefits?

You must apply for other programs within 30 days of being notified by your eligibility worker via the Notice to Apply for Other Maintenance Benefits (DHS-2116-ENG).

5. What should I do after receiving the “Notice to Apply for Other Benefits”?

You must:

1. Apply for the program(s) as instructed in the notice.
2. Provide all information and documents required by that program.
3. Give your eligibility worker documentation showing the decision from that program.

6. What happens if I’m denied other benefits?

• If denied because you’re not eligible, you do not have to appeal to keep your MA.
• If denied because you didn’t provide information or didn’t cooperate, you have not met the requirement and could lose your MA eligibility.

7. What if my MA was closed in the past for not applying for other benefits?

If your MA was previously closed for not applying, you do not need to apply for those benefits again before being newly determined eligible for MA.

8. Which specific benefits must I apply for?

a. Social Security Benefits (RSDI)

If you might qualify for Retirement, Survivors, or Disability Insurance, you must apply to keep your MA.
Family members of someone eligible must also apply for potential benefits.

b. Supplemental Security Income (SSI)

If you are 65 or older, or have a disability and low income, you must apply for SSI to maintain your MA eligibility.

c. Medicare

If you are eligible for Medicare, you must apply to keep your MA.

• If you qualify for Medicare Part A (hospital insurance) without a premium, you cannot refuse or drop it to stay on other health programs.
• If you have Medicare Part A, you must also enroll in Medicare Part B (medical insurance), even if it requires a premium.
• Exception: If you have current employer-based health insurance (yours, your spouse’s, or as a disabled child through a parent’s job), inform your eligibility worker and provide proof. You are not required to enroll in Part B in that case.

d. Medicare Part D

Enrollment is not required for MA eligibility, but:

• If you are eligible and don’t enroll, MA will not cover your prescriptions.
• Prescription costs not covered by Medicare can count toward a spenddown.
• MA and MSP enrollees who are Medicare-eligible automatically qualify for Extra Help and must select a benchmark plan (Senior Linkage Line can assist).

e. Veterans’ Aid and Attendance

If you are a veteran or spouse of a veteran who is over 65 or disabled and living in a long-term care facility, you must apply for Veterans’ Aid and Attendance benefits.

9. Do I need to reapply for benefits if I was denied before?

If you were previously denied and nothing has changed in your situation or the program’s rules, you do not need to reapply.