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Title 8: Medicaid Page 102 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Non-MAGI-Related Coverage Groups Revised October 10, 2025 People in Medicare Savings Programs

Step 3: Since there is no earned income, only the unearned income of Mr. A is used. $ 1046 – 20 $ 1026 Mr. A’ s gross social security Income exclusion Net countable income The $1026 is compared to 100% of the poverty level for a one-person household. Mr. A is income-eligible under QMB. The date of decision is the date the eligibility information is entered into the system. Eligibility for QMB begins the first day of the month after the month of decision, which means there is no QMB coverage for the month of application or the month of decision. This may affect the applicant’s choice of coverage groups.

1. Mr. B, age 83, applies for Medicaid on February 20. He wants assistance with his Medicare premiums, deductibles, and coinsurance. Eligibility is determined for QMB. The date of decision is March 12. The effective date of eligibility for QMB is April 1. 2. The household consists of Mr. K, age 72, and Mrs. K, age 59, who is disabled. The Ks file an application on January 5. The date of decision is January 29, which means that the effective date of eligibility for QMB is February 1. Review eligibility when changes are reported or made known. Complete a redetermination if the client no longer meets QMB requirements. Relationship Between QMB and Other Coverage Groups Legal reference: P. L. 100-360, 441 IAC 75 (Rules in Process), 76 (Rules in Process) An applicant who is eligible under more than one coverage group can choose under which coverage group eligibility is determined. Screen all applications for QMB and for eligibility under another coverage group. Explain the options under each group so the applicant can make an informed choice. Medicaid provides for some services not covered under Medicare, such as dental expenses and some prescription drugs.