Procedures

Follow the steps below to determine QI-1 eligibility.

Step 1 Accept the A/R’s QI-1 application. Since this is a time limited program, it is important to take and process applications in chronological order. Step 2 Contact the A/R by telephone only if information provided on the application is not sufficient to process the case. A face-to-face contact and office interview is not required at initial application or annual redetermination. 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 If the A/R has not been approved for Part A Medicare, but is entitled to free Part A obtain notification from SSA, scan into document imaging system and process QI-1 as though the A/R is currently covered by Part A Medicare. (If an A/R is required to pay a premium to receive Part A Medicare, they are not considered entitled for purposes of eligibility for QI-1.) Step 4 Determine all basic eligibility criteria except LOS and LOC. Accept the A/R’s statement regarding residency. Refer to Chapter 2200, Basic Eligibility Criteria. To fulfill the TPL requirement on a QI-1 applicant who has a TPL, copy the application and send to DCH only if the QI-1 applicant becomes Medicaid eligible under another COA. Step 5 Determine financial eligibility using QI-1 income and resource limits. Refer to the Section 2500 - ABD Financial Responsibility and Budgeting Overview to determine the following: whose income and resources to consider which QI-1 income and resource limit (individual or couple) to use which eligibility budget to complete Effective July 1, 2016, DCH adopted SSA’s Low Income Subsidy definition for “family of the size involved” for the QI1 Class of Assistance only . This means we will use the couple income and resource limit for the individual and the individual’s spouse, whether or not the spouse is applying (Medicare Eligible) for the QI1 MSP. We will continue to follow the approach of the SSI program under which either the standard for an individual or the standard for a couple will be used for the QMB and SLMB Medicare Savings Programs. 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. If BENDEX/SDX 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. Except for AMN, an individual cannot be dually eligible for QI-1 and another Medicaid COA for ongoing eligibility. If an active QI-1 A/R applies for and is approved ongoing under another COA, close the QI-1 case. Step 6 Approve QI-1 on the system if the A/R meets all the above eligibility Requirements. Step 7 Notify the A/R of the case disposition via the system generated notice.