0865.030.15 QMB Eligibility Continues When Another TOA Stops – DSS Manuals

When a QMB recipient who is also receiving another type of assistance, becomes ineligible for the other type of assistance, but the QMB eligibility continues, action must be taken to close the other case using regular IM-5/IMU5 procedures. In addition, the system requires re-entry of the QMB indicator. Failure to make this re-entry will result in an online edit stating, “QMB INDICATOR AND BEGIN DATE ENTRY REQUIRED”. Re-entry requires a “Y” in field 13M1 and the original date of eligibility in field 13M2 of the IMU5. When the system processes the above transaction, it closes the other assistance case, and opens a “QMB-only” case. This transaction appears on the Daily Transaction listing and generates a QMB turnaround IM-5 with a case action code of “08C”.

NOTE: AN ENTRY OF “Y” IN FIELD 13M1 IS, IN EFFECT, AN APPROVAL CODE FOR QMB ASSISTANCE. DO NOT MAKE THIS ENTRY UNLESS CONTINUING ELIGIBILITY FOR QMB HAS BEEN ESTABLISHED.

Always use the IMU5 transaction when closing a case in this situation to allow the system to automatically open the QMB case in an overnight function. ICLS cannot be used when closing any type of assistance in combination with QMB. If you attempt to close this type of case with the ICLS function, you will receive the edit message, “QMB INDIVIDUAL ON CASE. USE IMU5 TO CLOSE.”

As in other assistance, the date of the closing of a QMB case affects what type of notification is required to be sent to the client.

Closing QMB case before payroll closing date: If the closing action above occurs before the QMB payroll closing date, the client’s name appears on the QMB payroll for the following month and a QMB card is issued. (Payroll closing for QMB-only occurs on the first payroll closing date).

Closing QMB case after payroll closing date: If the closing action above occurs after the QMB payroll closing date, the Medicaid card from the other type of assistance is pulled (or the individual’s name lined out). The client’s name does not appear on the QMB payroll for the following month, therefore, the worker needs to send the client an IM-29(QMB) to show coverage for QMB for this one month. Send the IM-29(QMB) with the IM-33 notice advising the client of the closing of the other type of assistance. Send an IM-33 to the claimant, notifying him/her of ineligibility for the other type of assistance. This notice should also contain an explanation of the claimant’s continuing coverage for QMB, and include a copy of the IM-4QMB.