---
kind: "section"
citation: "42 C.F.R. § 403.808"
title: "42"
number: "403.808"
heading: "Use of transitional assistance funds."
url: "https://uscodex.org/cfr/42/403.808"
---

# §403.808. Use of transitional assistance funds.

- (a) **Individuals determined eligible for transitional assistance in 2004.** Subject to [paragraph (d)](#d) of this section, an individual who, in calendar year 2004, is determined eligible for transitional assistance under [§ 403.810(b)](/cfr/42/403.810.md?p=b) is entitled to the following:
  - (1) $600 in calendar year 2004; and
  - (2) $600 in calendar year 2005.
- (b) **Individuals determined eligible for transitional assistance in 2005.** Subject to [paragraph (d)](#d) of this section, an individual who, in calendar year 2005, is determined eligible for transitional assistance under [§ 403.810(b)](/cfr/42/403.810.md?p=b) is entitled to one of the following amounts for calendar year 2005:
  - (1) If the complete application for the individual's transitional assistance eligibility is received on or after January 1, 2005 and before April 1, 2005, $600.
  - (2) If the complete application for the individual's transitional assistance eligibility is received on or after April 1, 2005 and before July 1, 2005, $450.
  - (3) If the complete application for the individual's transitional assistance eligibility is received on or after July 1, 2005 and before October 1, 2005, $300.
  - (4) If the complete application for the individual's transitional assistance eligibility is received on or after October 1, 2005 and on or before December 31, 2005, $150.
- (c) **Payment of enrollment fee.** An individual found eligible for transitional assistance is entitled to have CMS pay the annual enrollment fee to the endorsed sponsor on his or her behalf.
- (d) **Conditions on use of transitional assistance.** A transitional assistance enrollee may access the transitional assistance described in paragraphs [(a)](#a) and [(b)](#b) of this section only if the following conditions are met:
  - (1) Except as provided in [§ 403.814(b)(3)(v)](/cfr/42/403.814.md?p=b-3-v), the transitional assistance funds are applied toward the cost of a covered discount card drug obtained under the Medicare Prescription Drug Discount Card and Transitional Assistance Program;
  - (2) The individual pays a coinsurance amount in accordance with [§ 403.808(e)](#e);
  - (3) The individual purchases the covered discount card drug on or after the individual's transitional assistance effective date; and
  - (4) The individual is enrolled in the Medicare Prescription Drug Discount Card and Transitional Assistance Program on the date the individual's claim for the covered discount card drug is adjudicated.
- (e) **Coinsurance.** If sufficient transitional assistance funds are available, transitional assistance funds must be expended in accordance with the following:
  - (1) For beneficiaries with incomes at or below 100 percent of the poverty line, 95 percent of the price of a covered discount card drug must be paid from the available transitional assistance funds.
  - (2) For beneficiaries with incomes greater than 100 percent but at or below 135 percent of the poverty line, 90 percent of the price of a covered discount card drug must be paid from the available transitional assistance funds.
- (f) **Rollover.** An individual with transitional assistance retains access to any balance of transitional assistance not expended in a calendar year during the next calendar year, up to and including the transition period, if the individual—
  - (1) Remains in his or her current endorsed discount card program;
  - (2) Elects a new endorsed program in an Annual Coordinated Election Period; or
  - (3) Is eligible for a Special Election Period under [§ 403.811(b)(2)](/cfr/42/403.811.md?p=b-2) and elects a new endorsed discount card program during such Special Election Period.

## Notes

### Source

Source: 68 FR 69915, Dec. 15, 2003, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.