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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2160

QUALIFIED INDIVIDUAL 1 (MQB-E)

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REVISED 12/03/2018 – CHANGE NO. 06-18

Current Change Notice: 06-18 • The Qualified Medicare Beneficiaries policies have been revised in the online Adult Medicaid Manual in the following sections: MA-2160, Qualified Individual 1 (MQB-E)

I. INTRODUCTION TO QUALIFYING INDIVIDUALS

Qualifying Individuals (QI1s/MQB-E) are beneficiaries who would be eligible for MQB- B except that their income is between 120 - 135% of the federal poverty limit. QI1s are also referred to as MQB-E.

Although eligibility regulations and benefits for QI1/MQB-E are the same as for MQB-B, the law mandates differences from the current MQB-B:

A. It is a capped entitlement. Funding is based on a fixed allocation at 100% Federal Financial Participation (FFP) through December of the current calendar year.

B. Approval is based on a first-come, first-served basis. When the number of QI1/MQB-E cases reach the capped allotment, Division of Health Benefits (DHB) will provide state wide notice to no longer approve applications for QI1/MQB-E.

C. There is no six month or 12 month certification period. Depending on the date the QI1/MQB-E application is taken, the certification period ends on December 31 of the current calendar year or December 31 of the next calendar year.

D. QI1/MQB-Es cannot be otherwise eligible or dually eligible for other Medicaid program.

II. QUALIFYING INDIVIDUALS POLICY FUNDAMENTALS

A. Eligibility

Except as noted below, the eligibility requirements and methodology for QI1/MQB- Es are the same as for MQB-B.

Inmates of public institutions are not eligible for Medicare

B. Income