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COMAR 10.09.24.03

358 State of Maryland Medical Assistance Manual Revised July 2012 The federal government approves the effective date for the State‟s payment of Medicare Part A for QDWI, based on the date of the SSA eligibility letter and when the individual applies for QDWI at the LDSS. The effective (begin) date of S06 eligibility will not necessarily be the 1st day of the month of application. The Centers of Medicare and Medicaid Services (CMS) will advise the DHMH Buy- In Unit of the effective date. The Buy-In Unit will inform the LDSS Case Manager if the effective date on CARES for S06 eligibility needs to be changed through an unscheduled redetermination.

Procedures

Once the CM has determinate that the A/R is eligible for QDWI benefits, the eligibility date should begin the same month as the date of the application. The case should be certified for a year and have a yearly redetermination.

When the CM is notified by the DHMH Buy-In Unit of the premium begin date, the CM must initiate an unscheduled redetermination to reset the effective date for a new 12 month certification period. A new application is not necessary because all eligibility factors remain the same.

o Complete the redetermination, which will reset the certification period forward 12 months. If for some reason the redetermination end date needs to be modified, shorten the redetermination end date as necessary to coincide with the begin date of premium payments. Suppress the CARES notices, and send manual QDWI notices to include the date the State will begin paying the Medicare Part A premium. A person must be under 65 years old to be eligible in this coverage group. The month before the customer turns 65, the CM will receive a CARES Alert (216). CARES will close the S06 AU at the end of the month in which the client turns age 65. As with all other MA coverage groups, the customer must be tested for MA eligibility in accordance with federal guidelines for delinking. o An individual who turns 65 year old during the consideration period must be determined for QDWI eligibility for any months prior to the attainment of 65. When the appropriate eligibility is determined and the notice sent advising the individual of the determination, the CM must also include a statement that they are not eligible once they reach age 65 because they are “potentially” eligible for free Medicare Part A. Also, they should contact SSA if they have not already been notified of this eligibility CMS will notify the DHMH Buy-In Unit when a person reaches 65 years old and the State‟s payment of the Medicare Part A premium is no longer due. The Buy-In Unit will then have the S06 case closed on MMIS effective the last day of the month of entitlement to S06 coverage. The Buy-In Unit will provide the information to the LDSS CM. The CM then must close the case