Adult Medicaid Manual MA-2140 QUALIFIED MEDICARE BENEFICIARIES-B

III. mQB-B SPECIAL PROGRAM REQUIREMENTS

A. Limited Coverage

1. MQB-B pays only the Medicare Part B premium.

2. MQB-B recipients do not receive a Medicaid card.

3. MQB-B recipients do not qualify for medical transportation because Medicare does not cover routine transportation.

B. Dual Eligibility

1. An individual (or couple) may be dually eligible for MAABD and MQB-B.

2. An individual must have his eligibility determined under all categories for which he might qualify.

C. Processing Requirements

The application processing time standard is 45 days.

1. If the applicant will not be enrolled and covered by Medicare Part A by the application processing standard, deny the MQB-B application according to procedures in MA-2304, Processing the Application.

NOTE: An individual who is eligible for premium-free Part A, but does not enroll during his enrollment period, can enroll only during the months of January through March of each year. Medicare Part A coverage is effective July 1^st of the enrollment year.

2. If the applicant will be covered by Medicare Part A prior to the processing deadline, the case may be authorized effective with the month of Part A coverage.

REVISED 04/01/08 – CHANGE NO. 13-08

(III.)

D. Disposition

1. If the applicant is eligible, approve MQB-B. Use the DMA-5002 or the DMA-5002S, to notify the a/r that:

“You are eligible for payment of Medicare Part B premiums only because your income exceeds the limit for other coverage. MMDDYY the State will begin paying your Medicare Part B premium.”

2. Refer to the EIS Codes Appendix, EIS-4000 for appropriate disposition approval code for automated notice.

E. Classification

The classification in EIS is “B.” Individuals will be MQB-B or MAABD-B if dually eligible.

F. Certification Period

1. The c.p. always begins with the month of application.

2. The c.p. is 12 months for MQB-B and MAABD-B.

G. Authorization

Authorize effective the month of application if all eligibility criteria are met.

For review, authorization begins the first month of the new c.p. if all eligibility criteria are met.

H. Retroactive Period

Unlike MQB-Q coverage, coverage for Medicare Part B only (MQB-B) can be authorized retroactively for three months prior to the month of application. Always provide retroactive MQB-B coverage if the applicant meets eligibility criteria and is not already covered under MAABD.

NOTE: Medical need is not an issue for MQB-B retroactive coverage. It is a requirement for MAABD.

I. Cost of Living Allowance (COLA)

Exclude the monthly amount of the RSDI COLA from countable income in determining eligibility for January, February, and March of each year. Use the prior December amount to determine eligibility for January through March.

REVISED 04/01/08 – CHANGE NO. 13-08

(III.I.)

Effective April 1 begin counting the increased RSDI benefit that was effective in January.

J. Redeterminations

1. A redetermination of eligibility is required prior to the end of the c.p.

2. Evaluate a/r’s eligibility for all Medicaid categories for which he may qualify.

3. Verify the following eligibility factors at every redetermination:

a. Medicare entitlement

b. Living Arrangement

c. Reserve

d. Income

e. Need