Procedures

Follow the steps below to determine QMB eligibility .

Step 1 Accept the A/R’s QMB application. A face-to-face contact and office interview is not required at initial application or annual redetermination. Step 2 Contact the A/R by telephone only if information provided on the application is not sufficient to process the case. Step 3 Verify Part A Medicare entitlement by one of the following: client statement, if copy of card or other written verification is not provided or available a RSDI Award Letter a Medicare card BENDEX, SOLQ under Interfaces in Gateway an MBR Query Card notification from a local SSA office Step 4 Determine all basic eligibility criteria except LOS and LOC. Accept A/R’s statement regarding residency. Refer to Chapter 2200, Basic Eligibility Criteria. To fulfill the TPL requirement on a QMB applicant who reports a TPL, copy the application and send to the DCH TPL Unit. Attach a copy of the insurance card if available. Step 5 Determine financial eligibility. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting to determine the following: whose income and resources to consider which QMB income and resource limit (individual or couple) to use which eligibility budget to complete For all applications and annual redeterminations: The A/R’s statement of income and resources provided on the application/review form is acceptable verification. No further verification is required unless questionable. Call, if needed, to confirm TPL status. If BENDEX/SDX/SOLQ or other information known to the agency indicates a different amount from the A/R’s statement and is determined to be current, use this amount over the A/R’s statement. If a Medicare eligible couple both apply for a Q-Track COA and they are income ineligible as a couple for all Q-Track COA, calculate their eligibility as individuals for income but jointly for resources and approve each under whichever Q-Track COA they are eligible. No property search is required for this class of assistance. The Social Security number of a spouse who is not applying for benefits is not required unless eligibility cannot be established without it. Step 6 Approve QMB on the system to begin the month following the month of case disposition if the A/R meets all the above eligibility requirements. However, if approval of the case is not completed within the standard of promptness due to agency or other agency delay, use the QMB override feature to not penalize the A/R for any month(s) in which the individual meets all of the eligibility requirements in that month, as long as it is for a month after the month of application. Step 7 Notify the A/R of the case disposition via the system generated notice.