Processing a QMB Application on an SSI Recipient

Effective August 1991, SSI Only recipients must apply for and be approved for QMB before DCH will pay the Part A Medicare premium through the buy-in process.

The following SSI recipients must apply for QMB at DFCS in order to have the premium paid by DCH:

Aged SSI Only recipients who are enrolled in Part B only. These individuals are eligible for Part A Medicare with a monthly premium. SSI Only (without RSDI or RR income) recipients who are age 65 or older are eligible for Part A Medicare with a monthly premium. The member will not receive Part A until the QMB application is approved.

SSI recipients (SSI only) whose claim number ends with an “M”. This information can be confirmed by viewing electronic sources such as (SDX, BENDEX and SOLQ).

The following SSI Only recipients will receive a letter from DCH informing them of the need to apply for QMB:

SSI applicants aged 65 or older who are newly approved by SSA to receive SSI

SSI recipients who reach age 65

The SSI Only recipient must submit an application for QMB through DFCS.

In October 2017, DCH issued a memorandum regarding SSI recipients eligible for Part B only (eligible for Medicare premium Part A). DFCS eligibility workers should accept and make an eligibility determination on an MSP application from any SSI-eligible individual , provided the individual is enrolled in Part A, Parts A and B, or Part B only. Although DCH pays the Medicare Part B premium for SSI-related Medicaid members when they become entitled, they must file an application with DFCS for QMB if they have a Medicare claim number that ends with “M" and wish to have the Part A Medicare premium paid by DCH.

Current SSI eligibility is prima facie evidence of financial eligibility for QMB. The SDX record showing current SSI pay status is acceptable verification. Document the case that the SDX screen has been viewed.

DFCS eligibility workers must enroll individuals in Medicare Part A buy-in after the QMB eligibility determination. Workers should not refer individuals to SSA to apply for Part A. Part B enrollment indicates they are eligible for Part A with a monthly premium.

Follow the steps below to establish QMB eligibility for an SSI Only and/or combo recipient.

Step 1 Register the applicant on the system. Step 2 Obtain information necessary to process the application. An interview is not required. Additional information may be obtained by contacting the applicant by telephone or mail. Step 3 Document QMB financial eligibility based on receipt of SSI. An SSI certification letter is acceptable verification if SDX is not available. Step 4 Scan a copy of the letter referring the recipient to DFCS to apply for QMB Into current document imaging system. Step 5 Verify potential Part A Medicare eligibility by one of the following: the DCH letter to the A/R regarding QMB and Buy-In the A/R’s DOB on SDX showing current age as 65 or older “AI” at the end of the SSI claim letter an SSI certification letter SOLQ If none of these methods of certification are available, request the A/R obtain a letter from SSA verifying potential eligibility for Part A Medicare entitlement. Step 6 Approve QMB to begin the month following the month of case disposition if the A/R meets eligibility requirements as an SSI recipient. Step 7 Notify the A/R of the case disposition via the system.