IMA POLICY MANUAL
PART VII: SPECIAL MA PROCESSING
CHAPTER 1: SPECIAL MA GROUPS AND PROGRAMS
AR: N/A
AX: N/A
SR: MA is available to widow(er)s age 60 through 64 who are not entitled to Medicare Part A (hospital insurance) and who became ineligible for SSI because of a Title II entitlement or increase.
MA is available to an individual who:
-
receives Title II benefits for early widow(er)s;
-
was terminated from SSI because of Title II payments;
-
was at least 60 years old but not yet 65 years old on August 2, 1988;
-
is not entitled to Medicare Part A; and
-
would be eligible for SSI if all Title II payments were excluded.
QM: N/A
GRANDFATHERED 1972 AND 1973 RECIPIENTS 1.9
AR: N/A
AX: N/A
SR: Individuals who would be eligible for SSI except for the 20 percent increase in Social Security benefits that occurred in August 1972 are eligible for Medicaid provided the individual would have been entitled to and receiving both Social Security benefits and cash assistance benefits.
In addition, individuals eligible for MA in December 1973 based on disability, blindness, status as an essential person, or institutionalization continue to be eligible for MA provided they have continued to meet the December 1973 criteria.
QM: N/A
DISABLED ADULT CHILDREN 1.10
AR: N/A
AX: N/A
SR: Persons who meet the following criteria are eligible for MA coverage:
-
at least 18 years old and have received SSI benefits on the basis of blindness or disability,
-
become entitled to Social Security child's benefits or an increase in such benefits on the basis of a disability that began prior to age 22, and
-
cease to be eligible for their SSI benefits because of the Social Security benefits.
QM: N/A
QUALIFIED MEDICARE BENEFICIARIES (QMB) 1.11
AR: N/A
AX: N/A
SR: N/A
QM: Certain Medicare beneficiaries, including persons receiving Title II benefits (Social Security), are eligible for Medicaid as QMBs. Coverage as a QMB means Medicaid will pay the following:
- Medicare Part A deductible,
- Medicare Part B annual deductible,
- Medicare Part B premium, and
- Medicare Part B annual copayments.
A QMB is an individual:
- Who is entitled to Medicare Part A (hospital insurance), including voluntary enrollment
- Whose income does not exceed 300 percent of the FPL
- Whose resources do not exceed twice the SSI resource limit
- Who meets the non-financial eligibility requirements of the MA program (see Part IV: Non-Financial Eligibility).
Income and resource eligibility are determined using SR methodologies.
Persons applying for eligibility as QMBs cannot spend-down income to meet QMB eligibility requirements.
Persons eligible as QMBs can also be eligible for Medicaid. Because the income standard for QMB is the same as the income standard for Aged/Disabled in SR, many of these individuals are also eligible for Medicaid. Such persons are described as dually-eligible.
QMB coverage begins the month after the month in which a person is determined to be eligible (i.e., if a determination is made on August 15, benefits are effective beginning September 1). Three-month retroactive eligibility is not available under the QMB provision.
If an individual eligible as a QMB receives Title II income, the amount of the Title II COLA is disregarded for the first three months of the calendar year, from January 1 through March 31. The Title II COLAs are disregarded to alleviate problems caused by the disparity between the effective dates of the COLAs and the annual adjustments made to the FPLs.
SPECIAL LOW-INCOME MEDICARE BENEFICIARIES (SLIMB) 1.12
AR: N/A
AX: N/A
SR: N/A
QM: A SLIMB is an individual who:
- is enrolled in Medicare Part A,
- has countable resources that do not exceed twice the SSI resource limit, and
- has income between 100 percent and 300 percent of the FPL.
Individuals and couples whose incomes are below 300 percent of the FPL are QMB eligible (see Section 1.10: Qualified Medicare Beneficiaries (QMB) in this Chapter).
Benefits for SLIMBs are limited to payment of the Medicare Part B premium only.
SLIMB coverage begins the month of application. Additionally, SLIMBs are eligible for the three-month retroactive eligibility determination.
There are no spend-down provisions for SLIMBs.
If an individual eligible as a SLIMB receives Title II income, the amount of the Title II COLA is disregarded for the first three months of the calendar year, from January 1 through March 31. The Title II COLAs are disregarded to alleviate problems caused by the disparity between the effective dates of the COLAs and the FPLs.
(Note that effective July 1, 2005, SLIMB eligibility applies only to the month of application and the three months prior to the month of application, since the QMB income limit has been increased to include these customers for the period beginning with the month following the month of application.)
