The purpose of this memo is to inform AIDS Drug Assistance Program (ADAP) enrollment workers that effective July 1, 2024, the California Department of Public Health (CDPH), Center for Infectious Diseases (CID), Office of AIDS (OA) has expanded MPPP Program benefits to include the payment of Dental and Vision premiums. All updates are in bold.

 Clients will have until August 31, 2024 to apply for dental and vision premium assistance with a July 1, 2024 start date. Applications received after August 31, 2024 will have a payment start date beginning the month their application is submitted.

Background

The Office of AIDS Health Insurance Premium Payment (OA-HIPP) and Employer-Based Health Insurance Premium Payment (EB-HIPP) programs provide dental and vision premium coverage for eligible clients. Currently, once a client becomes Medicare eligible, they no longer qualify for dental and vision premium assistance through OA-HIPP or EB-HIPP. MPPP provides Medicare Advantage plan (also known as Part C) premium assistance, Part D premium assistance, and Medicare supplemental or Medigap premium assistance. Medicare clients must pay for their own standalone dental and vision policies due to MPPP not covering these plans.

 Program Update

Effective July 1, 2024, new and existing MPPP clients will be eligible to receive assistance with their portion of their dental and vision insurance premiums from Medicare supplemental and Medicare Advantage plans. MPPP eligible clients, not enrolled in a Medicare supplemental or Advantage plan, can also receive assistance with standalone dental, or bundled dental and vision plan premiums. Standalone dental or combination dental and vision policies can be added to existing Medicare supplemental or Advantage plans if the current level of coverage is insufficient. MPPP clients can request dental and vision premium assistance anytime throughout the year.

 Please note, some Medicare Supplemental and Advantage plans already include dental and vision coverage that is bundled with medical coverage. Clients with these types of plans are not required to submit separate documentation.

 General Program Requirements

• Active ADAP enrollment
• Active MPPP Program eligibility (if a client is deemed 100% Low Income Subsidy [LIS] they are no longer eligible.)
• Medicare Part C / D premium information available through Centers for Medicare and Medicaid Services (CMS)

Enrolling a Client with a dental and/or vision plan into MPPP

At the time of MPPP enrollment or re-enrollment, the enrollment worker should ask the client if they have a dental and/or vision plan that they would like premium payment assistance with. If yes, the client will be required to submit the following supporting documentation to an ADAP enrollment worker or CDPH. Upload via “MPPP Supporting Documentation” Work Item for new dental or dental and vision applications, or “MPPP Premium/Plan Change" Work Item if changing dental or dental and vision plans in the ADAP Enrollment System (AES): ​

• Completed ADAP Attestation form with appropriate options selected
• “Applying for Medigap Premium Payments" if adding to existing Medigap policy
• “Applying for MPPP” if adding standalone dental or dental and vision bundle without Med​​igap policy
• Most recent dental and/or vision billing statements (dated within 30 days of application)

Documentation Requirements for Clients with Medicare Supplemental / Medigap Plans

The most recent Medicare supplemental plan billing statement must be uploaded in full to AES as an “Applying for Medigap Premium Payments” Work Item. Ensure that all pages with premium information are included. Medical, Dental, and Vision premiums should be listed separately to ensure accurate payments.

Documentation Requirements for Clients with Medicare Advantage or Part C Plans

The most recent Medicare Advantage or Part C billing statement must be uploaded in full to AES as an “Applying for MPPP” Work Item. A separate standalone dental or bundled dental and vision billing statement is required if premium assistance is being requested in addition to the included Medicare Advantage or Part C plan. This is not required if the medical, dental, and vision are bundled.

Documentation Requirements for Dental and Vision plans without Medicare Supplemental or Advantage Plans

The most recent Medicare dental or dental and vision bundled plan billing statement must be uploaded in full to AES as an “Applying for MPPP” work item. Standalone vision policies are not payable and must be bundled with a medical or dental plan.

 Once the ADAP Advisor verifies the completed forms, the client will be enrolled into MPPP and the ADAP Advisor will enter dental and/or vision plan information from the billing statement into AES.

 ​​If you have any questions regarding the information provided in this memo, please contact your OA Advisor.

Thank you,

​

Joseph Lagrama,

ADAP Branch Chief

California Department of Public Health