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2415.00.00 CATEGORICAL ELIGIBILITY FOR MEDICAID WAIVERS To be eligible under a Medicaid Home and Community-Based Services waiver, an individual must qualify under one of the specific aid categories that are approved for the waiver. Workers must ensure that waiver applicant/recipients are considered for Medicaid in the proper category. Verification of the specific waiver for which an individual is either applying or already approved, must be obtained from the waiver case manager. Please, refer to IHCPPM 3310.00.00 for permissible categories to receive HCBS waivers. There are various special eligibility provisions that are applicable in certain categories and under certain waivers as explained in Chapters 3300 and 3400.

2416.00.00 MEDICARE STATUS (MED 4)

Individuals whose status with the federal Medicare program meets certain requirements, and who also meet other eligibility requirements, can qualify for limited Medicaid coverage under a Medicare Savings Program (MSP, also known as Buy-In). The following four sections specify the categories under which this is possible.

If a member that is 65+ is eligible for Medicare, they are required to contact SSA and apply, including Part D (prescription coverage). If they fail to do so, Medicaid will not pay for Part D-eligible prescription drugs. Members should be directed to SSA.gov.

• If a member has Part B but no Part A, the worker should add Part A to the eligibility system with the same start date as the B. This will form the buy in category and pay for Part A (if not free to the member) if they qualify for one of the Medicare Savings Programs that pays for Part A premiums (as described in the following sections). Regardless of which Medicare Savings Program/Buy-In category the person may qualify for, these categories will not form if only Part B is added.

• If a member has Part A but no Part B, the worker should add Part B to the eligibility system with the same start date as the A. This will form the buy in category and pay for Part B.

2416.05.00 QUALIFIED MEDICARE BENEFICIARY (MED 4) The policy in this section applies to the MA L category of assistance. To be eligible as a Qualified Medicare Beneficiary (QMB) an individual must be entitled to Medicare Part A. An individual meets this requirement if he is enrolled in Medicare Part A or is eligible for enrollment if a monthly Part A premium is paid. Medicare Part A enrollment can be verified by viewing the Medicare card, a TPQY, or by correspondence from the SSA. If there is no Medicare Part A enrollment, those who are eligible for Medicare Part A with a monthly premium