MedicarePrescription Drugs

Best Available Evidence

Care1st Health Plan provides access to Part D drugs at the correct LIS level when provided with evidence of LIS eligibility regardless of whether or not the health plan and Centers for Medicare & Medicaid Services (CMS) systems match. Care1st Health Plan updates its system with the LIS status confirmed by the Best Available Evidence (BAE).

Care1st Health Plan accepts any of the following forms of evidence to establish the Low Income Subsidy (LIS) status of full benefit dual eligible beneficiaries:

A copy of the beneficiary’s Medicaid (Medi-Cal) card that includes the beneficiary’s name and an eligibility date*

  • A copy of a State document that confirms active Medicaid (Medi-Cal) status*
  • A print out from the State electronic enrollment file showing Medicaid (Medi-Cal) status*
  • A screen print from the State’s Medicaid (AEVS) system showing Medicaid (Medi-Cal) status*
  • Other documentation provided by the State showing Medicaid (Medi-Cal) status*
  • For individuals who are not deemed eligible but who apply, and are determined LIS eligible, a copy of the Social Security Administration (SSA) award letter

* During a month after June of the previous calendar year.

Care1st Health Plan accepts any of the following forms of evidence to establish that a beneficiary is institutionalized and qualifies for zero cost sharing:

  • A remittance from the facility confirming Medicaid (Medi-Cal) payment for a full calendar month for the beneficiary*
  • A copy of a State document that confirms Medicaid (Medi-Cal) payment on behalf of the beneficiary to the facility for a full calendar month after June of the previous calendar year
  • A screen print from the State’s Medicaid (Medi-Cal) system showing that the beneficiary’s institutionalized status based on at least a full calendar month stay for Medicaid payment purposes during a month after June of the previous calendar year

* During a month after June of the previous calendar year.

Click here for additional information about the CMS BAE policy.

CMS BAE policy - Learn more

Part D | Quality Assurance | Utilization Management | Explore Medicare

Care1st Health Plan is a Medicare Advantage Organization with a Medicare contract.