SUBJECT:
CLARIFICATION OF THE QMB, SLMB & SLMB-2 (QI-1) APPLICATION AND APPROVAL PROCESS AND MEDICARE BUY-IN
DISCUSSION:
The QMB, SLMB and SLMB-2 (QI-1) programs are commonly referred to as Medicare Cost Savings programs.
Effective immediately a Q (QMB) or L (SLMB) application must be registered in the system when a request for these types of assistance are received by a new applicant or current recipient of another type of assistance. These programs should be explored when taking an action on another type of assistance.
A claimant must be receiving Medicare Part A (hospital insurance) or be conditionally enrolled in Medicare Part A to be eligible for QMB or SLMB. Eligibility for Part A can be verified in the IIVE system. Individuals that are conditionally enrolled in Part A will show as a code 299 in the hospital insurance field.
The QMB begin date must be the month following the month of approval. SLMB and SLMB-2 (QI-1) can be approved for prior quarter coverage.
QMB pays the Medicare Part B premium and any Medicare co-payments or deductibles. SLMB and SLMB-2 (QI-1) only pay the Medicare Part B premium. Refer to the chart at on-line manual 0865.035.25.
Certain individuals are approved for Medicare Buy-In. This program and eligibility is administered by the Medicare Unit with the Division of Medical Services. Claimants receiving SSI or a cash grant are eligible for Buy-In. The only benefit of Buy-In is payment of the Medicare Part B premium. If an individual is showing eligible for Buy-In and they are also eligible for QMB, SLMB or SLMB-2 (QI-1), they should be approved for one of these programs.
NECESSARY ACTION:
- Share this memorandum with appropriate staff as soon as possible.