Adult Medicaid Manual MA-2160 QUALIFYING INDIVIDUALS 1 (QI1/MQB-E)

II. QUALIFYING INDIVIDUALS POLICY FUNDAMENTALS

A. Eligibility

Except as noted below, the eligibility requirements and methodology for QI1/MQB-Es are the same as for MQB-B.

B. Income

Must have countable monthly income between 120% and 135% of the federal poverty limit.

Refer to MA-2260, Financial Eligibility Requirements/PLA, for current QI1/MQB-E income levels.

C. Aid Program/Category Classification

The aid program/category classification code in EIS is MQB-E.

D. Coverage

Coverage for QI1/MQB-E is the same as for MQB-B. The only benefit is payment of the Part B Medicare premium. No Medicaid card is issued.

(II.)

E. Retroactive Coverage

Like MQB-B, QI1/MQB-Es can be authorized for retroactive coverage for up to 3 months prior to the month of application. However, coverage can never be authorized for a period prior to January of the current year.

F. No Dual Eligibility

Unlike MQB-Q and MQB-B, a QI1/MQB-E cannot be dually or otherwise eligible for Medicaid. This means:

1. An individual authorized for Medicaid in any other program (MAABD, SAAD, MAF, etc.) is not eligible for QI1/MQB-E, and

2. An individual whose application is pending to meet a deductible is not eligible for QI1/MQB-E, and

3. An ongoing recipient placed in deductible status is not eligible for QI1/MQB-E unless he elects to change coverage solely to QI1/MQB-E.

G. Processing Requirements

1. The application processing standard is 45 days.

2. QI1/MQB-E is subject to monitoring. Refer to MA-2305, Evaluating County/DDS Performance.

H. Ongoing Certification Period

1. QI1/MQB-Es do not have a standard six or 12 month c.p. The ongoing c.p. begins with the month of application for QI1/MQB-E.

2. If a QI1/MQB-E a/r subsequently becomes eligible under MAABD (or other aid program/category), the c.p. is not based on the ongoing QI1/MQB-E certification period. The c.p. begins with the month the a/r requests assistance under the new aid program/category.

I. Re-enrollments

Eligibility is redetermined for each calendar year. Refer to IV., below for re-enrollment procedures.