Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: INTRODUCING THE APPLICATION FOR MEDICARE SAVINGS PROGRAMS (IM-1MSP)
FORM REVISION #
IM-1MSP
IM-1MSP Large Print
IM-1MSP Spanish
IM-1QMB/SLMB – obsolete
IM-1QMB/SLMB Spanish – obsolete
DISCUSSION:
The Application for Medicare Savings for Qualified Beneficiaries or Specified Low-Income Beneficiaries (IM-1QMB/SLMB) has been renamed and revised. The IM-1MSP can be used by applicants to request assistance paying Medicare premiums.
The IM-1MSP has been revised to:
- Refer to MSP which could include: Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), Qualifying Individuals (QI), and Qualified Disabled Working Individuals (QDWI).
- Remove outdated references to food stamp assistance.
- Provide updated return information for Family Support Division (FSD) including the upload portal, mailing address and fax number.
- Provide a fillable PDF application.
- Allow an electronic signature.
- Simplify form fields and update language for consistency throughout the form and with other FSD forms.
The IM-1MSP has been converted to large print, IM-1MSP (Large Print). The IM-1MSP has also been translated and is available in Spanish, Solicitud para Programas de Ahorras de Medicare [IM-1MSP (Spanish)].
The IM-1QMB/SLMB and IM-1QMB/SLMB Spanish are now obsolete. FSD staff should begin using the IM-1MSP (7/2022) immediately and discard obsolete forms. Staff should share the revised IM-1MSP with community partners. The IM-1QMB/SLMB can be accepted as a valid application until 12/31/2022.
The IM-1MSP, IM-1MSP (Large Print), and IM-1MSP (Spanish) are available in the public and internal forms manuals. The IM-1MSP is available for authorized staff to order from the E-Store.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Begin using IM-1MSP immediately.
- Discard all obsolete forms.
KE/cj