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Job Aid Member Coverage Desciptions Version 1.0
5 © 2024 Gainwell Technologies. All rights reserved. Coverage Coverage Description Coverage Level 029 - Family Planning Waiver Covers women & men of childbearing age (13 - 44) at 185% of poverty who do not otherwise qualify for Medicaid. Effective 01/01/2014, MAGI-equivalent limit = 194% FPL. Females and males age 13-44. Benefits are limited to family planning benefits only. Benefits are limited to family planning benefits only 031 - Qualified Medicare Beneficiary (QMB) Income limit of 100% FPL, no asset test. Must be entitled to Medicare Part A and/or B to qualify. There is no retroactive Medicaid for this COE; Eligibility starts the month after approval. Aged (65 or over), blind, and disabled individuals. Medicare cost sharing services only: payment of Medicare Part A & B premiums, deductibles & co-insurance charges. Medicare cost sharing services only: payment of Medicare Part A & B premiums, deductibles & co- insurance charges 035 - Qualified Working Disabled Individual (QWDI) Participants must have Medicare. Income under 200% of FPL. Resource limits: $4,000 individual/$6,000 couple. Disabled (under age 65). Payment of Medicare Part A premium only. Payment of Medicare Part A premium only 045 – PLAD Healthier MS Waiver - no Medicare Covers up to 5,500 individuals in any month with income up to 135% of poverty who are aged or disabled and are not eligible for Medicare. Resource test of $4,000 for an individual, $6,000 for a couple. Disabled/aged individuals without Medicare. Benefits do not include long term care services (including HCBS waiver services) or maternity and newborn care services. Benefits do not include long term care services (including HCBS waiver services) or maternity and newborn care services. 051 - Specified Low-Income Medicare Beneficiary (SLMB) Specified Low Income Medicare Beneficiaries (SLMB) - Income limit between 100% - 120% FPL, no assets test. Must have Medicare Part A. Not fully eligible/Medicaid pays Medicare Part B premium only. Aged (65 or over), blind and disabled individuals. Payment of Medicare Part B premium only. Payment of Medicare Part B premium only 054 - Qualified Individual (QI) Income limit between 120% -135% FPL, no asset test. Must have Medicare Part A. Not fully eligible. Aged (65 or over), blind and disabled individuals. Medicaid pays Medicare Part B premium only. Payment of Medicare Part B premium only. Payment of Medicare Part B premium only