| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | CLARIFICATION OF THE QUALIFIED MEDICARE BENEFICIARY (QMB), SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLMB) & SLMB-2 (QI-1) APPLICATION PROCESS, QMB AND SLMB BENEFITS, AND MEDICARE BUY-IN PROGRAM |
DISCUSSION:
The QMB, SLMB, and SLMB-2 (QI-1) programs are commonly referred to as Medicare Cost Savings Programs. This memorandum clarifies processes and procedures regarding QMB and SLMB programs, provides information on certain requirements that must be met in order to receive QMB/SLMB assistance, explains the benefits available through both programs, and explains the Medicare Buy-In process.
Registering QMB/SLMB Application Requests
Effective immediately, a “Q” (QMB) or “L” (SLMB) application must be registered in the IAPP system when requests for these types of assistance are received by a new applicant or current recipient of another type of assistance. Registering QMB and SLMB applications is necessary to track the number of applications received and to track due dates for processing these applications. All requests for QMB and SLMB coverage must be processed within 45 days from the date of application.
Exploring QMB/SLMB Eligibility at Application and Reinvestigation
Always explore QMB and SLMB assistance when taking a new application or when completing a reinvestigation or case action for other types of assistance. If the claimant does not already receive QMB or SLMB coverage and appears to be eligible, discuss the benefits of QMB or SLMB and take appropriate action based on what is in the best interest of the claimant. This is important because QMB pays Medicare coinsurance, deductibles, and some non-Medicaid services. Non-Medicaid services covered by Medicare include services provided by independent psychologists, physical therapists and occupational therapists, and chiropractors. In addition, QMB, SLMB, and SLMB-2 (QI-1) recipients are deemed eligible for low income subsidy, Social Security Administration’s program to help individuals with limited income and resources in paying for premiums and co-pays associated with Medicare Part D prescription drug coverage.
Enrollment in Medicare Part A and Eligibility Begin Dates
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. Verify eligibility for Medicare Part A in the IIVE system. Individuals conditionally enrolled in Medicare Part A show as code "Z99" in the field following the Hospital Insurance information. For conditional enrollment cases, if the IIVE is returned showing no Part A entitlement, the eligibility specialist must contact the local Social Security Administration office for clarification before the QMB or SLMB application is rejected for no participation in Medicare Part A. The QMB coverage begin date must be the month following the month of approval, however, SLMB-1 and SLMB-2 (QI-1) can be approved for prior quarter coverage.
QMB Benefits
QMB pays the recipient's Medicare premiums, both Part A (if a premium payer) and Part B. Part B premiums are paid through the Division of Medical Services (DMS) Buy-In system. The DMS Buy-In Unit handles payment of Medicare Part A premiums through a separate process. In addition, QMB pays any Medicare co-payments or deductibles. Refer to on-line manual Section 0865.035.25 to access the QMB Benefits Guide.
SLMB Program Benefits
The SLMB and SLMB-2 (QI-1) programs only pay the Medicare Part B premium.
Buy-In Program
Claimants receiving SSI or a Supplemental Aid to Blind (SAB), Supplemental Nursing Care (SNC), or Supplemental Payment (SP) cash grant, or Medical Assistance for Families (MAF) are eligible for Buy-In. This program and eligibility are administered by the Division of Medical Services Medicare Unit. The only benefit of the Buy-In program is payment of the Medicare Part B premium.
Medicare Buy-In eligibility should not be confused with QMB and SLMB eligibility. If an IIVE shows an individual eligible for Buy-In, this does not necessarily mean that they are already receiving QMB, SLMB, or SLMB-2 (QI-1) assistance. It is important to check to see if the individual is on QMB, SLMB, or SLMB-2 (QI-1) assistance. If s/he is not, but would be eligible for QMB, SLMB, or SLMB-2 (QI-1), approve him/her for QMB, SLMB, or SLMB-2 (QI-1) assistance.
NECESSARY ACTION:
- Share this information with appropriate staff as soon as possible.
- Discuss the benefits of QMB and SLMB with applicants and recipients of other types of assistance and Medicare Buy-In.
- Register QMB and SLMB applications received.