0865.020.00 Application Processing (QMB)

0865.020.15.15 Requests for QMB Coverage on Active Cases

Some individuals will not be Part A Medicare eligible when they apply for Medicaid, and therefore, not QMB eligible. If an individual receiving some other type of assistance subsequently becomes Part A eligible and requests QMB coverage, take the following actions:

  • Register an application for a QMB (“Q” type of assistance) using IAPP procedures. Do not require the claimant to sign an IM-1 or complete any other application forms. Use the date of request as the date of application for QMB.
  • Determine eligibility for QMB. If eligible, report the QMB coverage in Field 13M1 and 13M2 of the other type of assistance. When this transaction is entered, the system automatically rejects the application with the “Q” type of assistance using a case action code of “20C”. The claimant is then covered for QMB in addition to whatever other type of assistance s/he may have.
  • If the claimant is not QMB eligible, complete an IMU5 transaction to reject the QMB type of assistance, using standard rejection procedures.