Traditional MedicareAdministrativeMedium impact
Residents in Medicaid Pending Status
Illinois Medicaid - HFS·IL · Geriatrics·Provider Notice
Effective date
Jun 10, 2008
We identified it
Jun 21, 2026
Summary
Long-term care providers must screen Medicare-eligible residents in Medicaid pending status for Medicare Part D enrollment and low-income subsidy eligibility during admission. Medicare-eligible residents cannot receive Medicaid drug coverage and must have Part D coverage to avoid gaps in prescription drug benefits.
Action Required
Immediately: Long-term care billing teams must update admission protocols to screen all residents for Medicare eligibility. Assist Medicare-eligible residents with applying for low-income subsidy through Social Security Administration (1-800-772-1213) and enrolling in Medicare Part D plans. Bill prescription drugs to Medicare Part D plans, not Medicaid, for dual-eligible residents.