Best Available Evidence of Low Income Subsidy for Prescription Drugs (BAE)

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

If you believe you have qualified for Extra Help and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, our plan has established a process that allows you to either request assistance in obtaining evidence of your proper co-payment level, or, if you already have the evidence, to provide this evidence to us.

When we receive your evidence, it is considered the “Best Available Evidence” and we will enter that information into our system and the pharmacy’s system to correct your LIS level. This will help the pharmacy to charge the right amount for your prescriptions.

Vitality Health Plan of California will accept the following documents as evidence of your proper co-payment level. These documents can be provided by you your pharmacist, advocate, representative, family member or other individual acting on your behalf, by mail or fax. Any document you submit must show that you were eligible for Medicaid during a month after June of the previous calendar year: A copy of your Medicaid card that includes your name and eligibility date.

  • A copy of a state document that confirms active Medicaid
  • A print-out from the State electronic enrollment file showing Medicaid status
  • A screen print from the State’s Medicaid system showing Medicaid status
  • Other documentation, such as a copy of your SSA award letter, provided by the State showing your Medicaid status
  • A Supplemental Security Income (SSI) “Notice of Award” with an effective date
  • An "Important Information" letter from SSA confirming that you are automatically eligible for extra help

The following documents are required if you are institutionalized. Any document you submit must show that you were eligible for Medicaid during a month after June of the previous calendar year: Remittance from the long-term care facility showing Medicaid payment for a full calendar month.

  • A copy of a state document that confirms Medicaid payment on your behalf to the long-term care facility for a full calendar month
  • A screen print from the State's Medicaid systems showing your institutionalized status, based on at least a full calendar month's stay for Medicaid payment purposes

For additional information about the CMS BAE policy, Visit the CMS Website.

Last updated 12/20/2018