Adult Medicaid Manual MA-2355 MAABD/MQB PROGRAM TRANSFERS

III. TRANSFERS FROM M-AABD TO MQB-Q or B

A. Transfer an M-AABD a/r to MQB-Q or B if a change in situation makes him ineligible for M-AABD. For example:

1. The a/r has a deductible which he cannot meet.

2. The a/r’s resources increase above the M-AABD limits but are less than MQB limits.

B. Ongoing M-AABD Cases

NOTE: If the M-AABD recipient is transferring back to MQB-Q or B within the latest 12 month MQB-Q or B certification period, maintain the original 12 month M-QB certification period. It is not necessary to review the case at this time. However, you must review before the end of the MQB 12 month certification period.

1. If the recipient has a change in income or reserve which causes ineligibility for M-AABD, or which causes a deductible for which there are not enough medical bills to meet:

a. Treat as a change in situation.

b. Review the reserve information to determine if the recipient meets the M-QB requirements. It is only necessary to reverify reserve that is subject to change.

c. Recompute income based on verified income information in MA-2250.

(1) It is only necessary to reverify income that is subject to change (such as wages).

(2) For other types of income not subject to change (such as Social Security or retirement benefits), ask the recipient if there have been any changes. If not, it is not necessary to reverify.

(III.B.)

2. If the recipient meets the requirements for MQB-Q or B:

a. Notify the recipient on the DSS-8110 (timely) that his case is being transferred to MQB-Q or B because he is no longer eligible for M-AABD. State on the notice that Medicaid will pay only the Medicare premiums, deductibles and copayments.

(1) If the recipient has a deductible, he may provide bills to meet the deductible within the timely notice period.

(2) If the recipient provides bills to meet the deductible, continue as M-AABD.

b. Transfer to MQB-Q or B. Follow instructions in EIS-3451.

c. Enter the new certification period in EIS. The MQB certification period is 12 months or the remaining 6 months of original 12 month certification period if client had already transferred from MQB to MAABD.

For example, if the recipient reported a change during a January-June M-AABD certification period, the M-QB certification period is January-December.

3. When doing the review at the end of the MQB-Q or B certification period for a recipient who has transferred from M-AABD to MQB:

a. Recertify as MQB with a 12 month certification period if:

(1) The recipient has resources above the M-AABD limits but within the M-QB limits.

(2) The recipient would have a deductible but does not have enough bills to meet the deductible.

b. Transfer the case back to M-AABD effective the first day of the new certification period, and recertify with a 6 month certification period if:

(1) The recipient is eligible for M-AABD CNNMP or MN with no deductible and has resources within the CNNMP or MN limits.

(2) The recipient has a deductible but has already incurred enough bills to meet the deductible and has resources within the M-AABD limits.

c. The a/r is dually eligible if he continues to meet the requirements for both M-AABD and MQB-Q or B.

For questions or clarification on any of the policy contained in these manuals, please contact your local county office.