0840.010.40 Participant Becomes Eligible for Medicare – DSS Manuals

IM-98 December 1, 2023

When a participant reports they are receiving Medicare, explore potential eligibility for a Medicare Savings Program (MSP).

MSPs help those qualified afford Medicare. There are four MSPs, each with different income and resource eligibility limits. These programs are:

Qualified Medicare Beneficiaries (QMB) (see 0865.000.00 Qualified Medicare Beneficiaries (QMB) )

Specified Low-Income Medicare Beneficiaries (SLMB1) (see 0870.000.00 Specified Low-Income Medicare Beneficiaries (SLMB1) and Qualifying Individuals (SLMB2) )

Qualifying Individuals (SLMB2) (see 0870.000.00 Specified Low-Income Medicare Beneficiaries (SLMB1) and Qualifying Individuals (SLMB2) )

Qualified Disabled Working Individual (QDWI) (see 0860.000.00 Qualified Disabled Working Individuals (QDWI) )

Automatically enroll MO HealthNet (MHN) participants in QMB and SLMB1 when it is determined they are eligible.

SLMB2 participants cannot receive any type of MHN.

QDWI participants cannot be eligible for any type of MHN.

Note: When a participant becomes eligible for QMB or SLMB1, the Medicare premium (SMI) is no longer an allowable deduction for MHABD. This may cause an increase in spend down or cause a non-spend down participant to have a spend down. A participant may choose to close QMB or SLMB1 coverage.