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Effective: December 1, 2006 |
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03.35.15ar1 - Qualified Individuals (QI) (Archive) |
Archived: May 1, 2007 |
Certain people who meet all Qualified Medicare Beneficiary (QMB) requirements, but have excess income for QMB, may be eligible as Qualified Individuals (QIs). To be eligible as QIs, people must:
l Be enrolled or are eligible to enroll in Medicare Part A and eligible to enroll in Medicare Part B.
l Have income in excess of both the QMB limit of 100% FPG and the SLMB limit of 120% FPG but within the QI limits described below.
People who are not eligible for premium-free Part A and choose to enroll in Part B only may apply for QI to cover the premium payment.
Medicare-eligible people are age 65 or older, blind or disabled. Some disabled people who no longer receive a cash benefit from the Social Security Administration (SSA) due to work but remain medically disabled have extended Medicare coverage and are potentially eligible for QI. See Medicare Savings Programs for more information on these situations.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
QI benefits are funded through a capped federal entitlement. Enroll eligible applicants on a first-come, first-served basis in the order in which they apply. DHS will notify counties if the QI allocation is exhausted for a particular year.
QI benefits are available for the three months before the month of application, as well as for the application and ongoing months, for people who meet all eligibility requirements.
Renewals (standard guidelines)
Do not require six-month renewals for QI enrollees who meet any of the exceptions noted in six-month renewals.
Verify enrollment in Medicare Part A when required for QI eligibility.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard guidelines for federally funded MA.
Residency (standard guidelines)
Follow standard MA guidelines.
DHS pays Medicare Part B premiums through the buy-in for people who are enrolled in QI.
Household Composition (standard guidelines)
Follow standard MA guidelines.
Use Method B for income and assets.
Asset Guidelines (standard guidelines)
Asset limit is:
l $10,000 for a household of one.
l $18,000 for a household of two or more.
Income Guidelines (standard guidelines)
Income must be greater than 120% FPG but less than or equal to 135% FPG.
In addition to allowing the income deductions and disregards for the applicable age 65 or older, blind, or disabled status, apply the standard $20 disregard when determining QI eligibility.
Disregard RSDI cost-of-living adjustments (COLA) for January through June of each year.
Deduct allocations for the needs of relatives of a long-term care (LTC) client from income when determining QI eligibility.
Spenddowns (standard guidelines)
There are no spenddown provisions for QI.
The benefit of the QI program is payment of the Medicare Part B premium.
Service Delivery (standard guidelines)
People who are eligible for only QI are excluded from managed care enrollment.
Not applicable.
Not applicable.
Relationship to Other Groups/Bases (standard guidelines)
People cannot be concurrently eligible for QI and any of the following programs:
l MinnesotaCare.
l Medical Assistance (MA).
Exception: MA and QI may overlap in the retroactive eligibility circumstances noted below.
l Qualified Medicare Beneficiary (QMB).
l Service Limited Medicare Beneficiary (SLMB).
l General Assistance Medical Care (GAMC).
MA and QI may overlap when a person receiving QI benefits requests retroactive MA. If MA eligibility will continue beyond the month in which eligibility is approved, close QI for the first month for which you can give ten-day notice.
Example:
John is eligible for QI benefits. On September 12, he applies for MA and requests coverage retroactive to July. On October 15, the worker finds him eligible for MA effective July 1 and continuing.
Action:
Close QI effective November 1. If John qualifies for QMB or SLMB, open whichever is appropriate.
People residing in Institutions for Mental Diseases (IMDs) are not eligible for QI unless they meet one of the conditions that allow MA eligibility in an IMD.
People can receive Alternative Care (AC) and QI at the same time.
Not applicable.