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Chapter: 1400 Technical Requirements Program: MSSI, SFP 53 1440.1504 Receipt or Entitlement to Medicare Part A (MSSI) Individuals must be enrolled in Medicare Part A as a condition of eligibility for Qualified Medicare Beneficiary (QMB).

When a person who is otherwise eligible for QMB (for example, someone who has reached age 65, and is a US resident, a citizen or lawful permanent resident, with income at or below 100% of the federal poverty level, assets within QMB asset limit) but does not have Part A, they must go the Social Security Administration to enroll for Medicare. The usual open enrollment period does not apply. SSA needs only a letter from DCF stating the person is QMB eligible and the state will pay the premium. This is what is referred to as conditionally enrolled.

Individuals must be enrolled in Medicare Part A as a condition of eligibility for Special Low- Income Medicare Beneficiary (SLMB) and Qualifying Individuals 1 (QI1). To qualify for SLMB or QI1, an individual must have either free Part A or their Part A premiums must be paid by someone other than the state. Medicare beneficiaries whose Medicare claim number ends in “M” do not have free Part A and, therefore, do not qualify for SLMB or QI1 benefits unless they are paying their own premium or someone other than the state is paying their premium.

Individuals must be entitled to enroll for hospital insurance benefits as determined by SSA as a condition of eligibility for working disabled benefits. 1440.1600 ASSIGNMENT OF RIGHTS FOR TPL (MSSI) This section discusses the requirement for assigning to the state any right to any third party payment (TPP) for medical care. 1440.1601 Assignment of Rights to TPP (MSSI) Individuals must assign to the state their right to any third party payment for medical care.

When a child resides with a nonrelative, the child's parent, caretaker relative, or the designated official of the facility must cooperate with the state in obtaining third party payments. They must assign to the state, when legally able, the rights of the child to any third party payments.

Third party payments include but are not limited to the following:

1. insurance policies, 2. court ordered medical support, and 3. irrevocable trusts which provide for medical expenses (under Florida law this assignment is automatic when receiving Medicaid, and the individual's signature on the application acknowledges the assignment). 1440.1602 Identification of Third Party Liability (MSSI) Individuals must cooperate in identifying all potential third parties who may be liable to pay for their care. An individual who refuses to cooperate is ineligible for assistance unless the individual has good cause not to cooperate. Inability to provide the requested information does not constitute refusal to cooperate. If good cause does not exist, the needs of the individual must be removed from the SFU; however, the individual's income and/or assets must be considered. This individual continues to be entitled to the earned income disregards, if otherwise eligible.

Good cause includes situations in which the individual claims that the revealing of third party sources would result in physical or emotional harm to the individual. Cases involving good cause should be referred through the Region or Circuit Program Office to Headquarters for clearance.