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Chapter: 2000 Coverage Groups Program: MSSI, SFP 23

1. Are enrolled in Medicare Part A under this special extended coverage (as confirmed by SSA) 2. Are under age 65, 3. Have assets at or below $4,000 for an individual and $6,000 for a couple, 4. Have income at or below 200% of the federal poverty level (individual or couple), 5. Are U.S. citizens or qualified noncitizens, 6. Take necessary steps to access any other benefits to which they may be entitled. 2040.0817 Qualified Medicare Beneficiaries Medicaid (MSSI) To be eligible to receive Medicaid through the Qualified Medicare Beneficiaries Program (QMB), an individual must meet all the following criteria:

1. Be enrolled (or conditionally enrolled) in Medicare Part A; 2. Have income that does not exceed 100% of the federal poverty level; 3. Have assets not exceeding three times the SSI resource limit with annual increases based on the yearly Consumer Price Index (refer to Appendix A-9); 4. Be a U.S. citizen or qualified noncitizen; and 5. Take necessary steps to access any other benefits to which they may be entitled.

Individuals who are QMB eligible receive limited Medicaid benefits. Medicaid benefits are limited to payment of the Medicare premiums, coinsurances and deductibles for qualified individuals. This includes full Medicare coinsurance payment for nursing home care. The QMB eligible individual has no patient responsibility while under the Medicare coinsurance benefit period.

Medicaid eligible individuals who meet QMB criteria do not have to apply for the Institutional Care Program (ICP) if they do not remain in the nursing facility beyond their Medicare benefit period. The facility can automatically bill for the Medicare coinsurance payment. If the individual remains in the facility beyond the Medicare benefits period, conduct a partial review (or eligibility review if an eligibility review is due or extensive verification is needed) to provide full ICP services if necessary.

Note: Cross reference passage 1440.1504. 2040.0818 Special Low Income Medicare Beneficiary (MSSI) To receive benefits through the Special Low Income Medicare Beneficiary Program (SLMB), an individual must meet all of the following eligibility criteria:

1. Be enrolled in Medicare Part A; 2. Have income between 100% and 120% of the federal poverty level; 3. Have assets not exceeding three times the SSI resource limit with annual increases based on the yearly Consumer Price Index (refer to Appendix A-9); 4. Be a U.S. citizen or qualified noncitizen; and 5. Take necessary steps to access any other benefits to which they may be entitled.

Individuals who are SLMB eligible receive payment of their Medicare Part B premiums.

Note: Cross reference passage 1440.1504. 2040.0819 Qualifying Individuals 1 (QI1) (MSSI) This mandatory federal program pays the monthly Medicare Part B premium for individuals who would be, QMB or SLMB eligible except for the fact that their income exceeds those program limits. This is not an open entitlement program as funding is limited to an annual federal allocation.