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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |118 Effective Month: September 2018 • Has not previously applied for Medicare & states no Medicare application is pending • No access to free Medicare Part A, take action as follows: Income is at/below 100% FPL- All COE’s including QMB-Only Income is above 100% FPL – COE’s other than SLMB and QI A/R can apply & accept Medicare Part A under conditional enrollment, i.e., meaning Part A will be accepted only if state agency pays the premium. Individual must also apply for Medicare Part B at same time. • Set an alert to check on Medicare status at the end of 30 days from date referred to SSA to apply. A SVES response with a Z99 code in the HI Effective Date field verifies conditional enrollment is complete. • If otherwise eligible, approve eligibility in appropriate COE. • Enter Medicare data in MEDS using an effective date for Medicare Part A and B that is the month after the month of approval for both QMB-only and QMB-dual approvals. • DOM will pay all Medicare A/B cost- sharing expenses. A/R does not have to accept Medicare Part A because DOM will not pay the Part A premium. A/R can apply and accept Medicare Part B unless eligible for or applying for COE-045. Since the Healthier MS Waiver does not allow Medicare coverage, the A/R cannot be required to accept Medicare and move to a COE that does not pay all associated Medicare costs. Income is above 100% FPL – SLMB and QI COE’s A/R can apply and accept Medicare Parts A and B for SLMB and QI. Must have active Part A before eligibility in SLMB or QI can be approved. Verify Part A is active prior to approval in either COE. INDIVIDUAL HAS PREVIOUSLY APPLIED FOR MEDICARE CURRENTLY HAS NO MEDICARE, OR PART A ONLY OR PART B ONLY If A/R has previously applied for Medicare Part A and/or Part B and coverage for all/either Parts A/B were Refused (R), Withdrawn (W) or Terminated (T) due to non-payment of premiums, do not refer the individual to reapply If A/R meets one of these 3 conditions, SVES should display an R, W, or T in the HI Option Code and/or the SMI Option Code. Take the following action based on income level: Income is at/below 100% FPL- All COE’s including QMB-Only Income is above 100% FPL – COE’s other than SLMB and QI If A/R does not have active Medicare Parts A and B, staff with the Buy-In Program must manually open or reopen Medicare. Send an If A/R does not have active Parts A and B: