0865.000.00 Qualified Medicare Beneficiaries (QMB)

0865.030.20 Both QMB and Another TOA Are Closed

When a QMB recipient is found to be ineligible for both QMB and the other type of assistance (or is removed from both cases), close the case of the other type of assistance through the use of regular IM-5/IMU5 procedures. At the same time, close the QMB case by entering an ā€œNā€ in field 13M1 of the IM-5/IMU5. (This is a required entry field for a closing. Failure to enter an alpha code in this field will result in an online edit).

NOTE: AN ENTRY OF ā€œNā€ IN FIELD 13M1 IS, IN EFFECT, A CLOSING CODE FOR QMB ASSISTANCE. DO NOT MAKE THIS ENTRY UNLESS INELIGIBILITY FOR QMB HAS BEEN ESTABLISHED.

Send the client an IM-33 Notice of Ineligibility and include both the QMB case and the other type of assistance. Be sure to state the reasons for ineligibility in each program.