Page 13

o QMB: A Medicare beneficiary whose income does not exceed 300 percent of the Federal Poverty Level is called a Qualified Medicare Beneficiary (QMB). For an individual eligible for Medicaid in the QMB category, the Medicaid program pays the following:  Medicare Part A deductible*,  Medicare Part B premium,  Annual Part B deductible*, and  Annual Part B Copayments*

* The District's policy restricts reimbursement to those infrequent situations where the total Medicare payment is less than the Medicaid fee schedule. Consequently, Medicaid rarely if ever pays these amounts.

Note that effective November 1, 2008, there is no asset limit for QMB.

o SLIMB: A Medicare beneficiary whose income is at least 100 percent of the FPL and less than 300 percent of the Federal Poverty Level is called a Special Low-Income Medicare Beneficiary (SLIMB). For an individual eligible for Medicaid in the SLIMB category, the Medicaid program pays the Medicare Part B premium. (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.)

Note that effective November 1, 2008, there is no asset limit for SLIMB.

o QI-1: A Medicare beneficiary whose income is at least 120 percent of the FPL and less than 135 percent of the FPL and whose resources are no more than twice the SSI resource standard is called a QI-1. For an individual eligible for Medicaid in the QI-1 category, the Medicaid program pays the Medicare Part B premium. (Note that effective July 1, 2005, there are no QI-1 eligible customers, since the QMB and SLMB income limits have been increased to include these customers.)

o QDWI: A Qualified Disabled Working Individual (QDWI) is a disabled individual who lost his/her free Medicare Part A benefits due to his/her return to work and:

 is receiving or is eligible to receive Medicare Part A,  has income that does not exceed 200 percent of the Federal Poverty Level,  has assets that do not exceed twice the SSI standard, and  is not eligible for MA under any under standard.

For an individual eligible for MA as a QDWI, the Medicaid program pays the Medicare Part A premium.

A Medicare beneficiary who is eligible under one of the above categories and is also eligible for Medicaid based on another eligibility criteria, such as an individual who is 65 years of age or older and has income below the poverty line, will receive assistance paying for Medicare premiums, etc. and will also receive Medicaid-provided services not covered under the Medicare program.

 Immigrants: Depending on their status, immigrants may be eligible for full-coverage Medicaid or emergency Medicaid services. o Refugee-Related Medicaid: Refugees, asylees, and certain other immigrants in their first eight months in the country are eligible for Medicaid if their income and assets are below