Page 38
MEDICAL SERVICES POLICY MANUAL,SECTION A
A 200 Health Care CoveragePeriods
3. Medicare Savings Program exceptions: a. QMB-The effective date of coverage is the first (1st) day of the month following the month of approval. b. SMB-The effective first (1st) date of coverage is the first (1st) day of the month of application. Coverage must always begin on the first (1st) day of the month. c. QI-1- The effective day of coverage is the first (1st) day of the month of application. Coverage must always begin on the first (1st) day of the month. d. QDWI-The effective day of coverage will be the first (1st) day of the month based on the date of the application and the date on which all eligibility factors are met, including the effective month of Medicare Part A. 4. Medically Needy Groups (Exceptional and Spend Down) With date specific eligibility, an individual’s or family’s eligibility for exceptional Medically Needy may begin or end on any day of a month. When found eligible, the certification period will begin on the day application was made, unless retroactive coverage is needed. If retroactive coverage is needed and if eligibility is established, the certification period may begin up to three (3) months prior to the date of application (but not on the first(1st) day of a retroactive month, unless application was made on the first (1st) day of a month). Termination may occur at the time of reevaluation or by reported changes that affect client eligibility. The spend down period is the three (3) calendar months used in determining eligibility. The spend down quarter can be any continuous three (3) calendar month period between the first (1st) day of the three (3) month retroactive period (three (3) calendar months prior to the application month) and the last day of the three (3) month period beginning after the application month. The three (3) months chosen for the spend down period should be the three (3) months in which the applicant has the greatest medical expenses, or the three (3) months in which they would receive the greatest benefit. See MS E-300 - 340. Refer to MS A- 210 through MS A-215 for retroactive eligibility for each category listed above.