MEMORANDUM

DISCUSSION:

This purpose of this memorandum is to provide instructions for processing the Medicare Savings Program (MSP) Model Application designed by the Social Security Administration (SSA), available on the SSA website. 

The Family Support Division (FSD) will accept this application to preserve an application date for Qualified Medicare Beneficiary (QMB) or Specified Low Income Beneficiary (SLMB) applications.  However, the MSP does not capture all information needed to complete an eligibility determination for MO HealthNet QMB or SLMB.  The MSP does not ask about citizenship, state residence, intent to remain, burial plans, or include the same attestation of understanding and full disclosure as is on the IM-1 QMB/SLMB. 

NOTE:  The MSP will not preserve the date for MO HealthNet for the Aged, Blind, and Disabled (MHABD) application.

When an MSP is received the eligibility specialist will:

1. Register the application, using the date the MSP is received by FSD as the application date.
2. Complete the conflows in FAMIS.
   1. If verification of citizenship is not populated from a previous application, answer yes, without entering verification.
   2. Answer resident with intent to stay, yes without verification.
   3. Update the FA325 with request for information about burial plans the applicant or spouse own.
   4. Enter a comment on the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen labeled "MSP APPLICATION-FURTHER INFO NEEDED"
   5. Update the FA325 with instructions to complete and sign the IM-1 QMB/SLMB form.
3. Mail the FA325 along with a blank IM-1 QMB/SLMB and IM6AR to the applicant.

NOTE: A Representative/Sponsor identified on the MSP is not an acceptable designation as Authorized Representative, as it does not include the minimum described in Memorandum IM-33 dated 4/20/15.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Accept the MSP to preserve the application date for QMB/SLMB applicants.

JG/vb