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Must have countable monthly income between 120% and 135% of the federal poverty limit.

Refer to MA-2260, Financial Eligibility Requirements/PLA, for current QI1/MQB-E income levels.

C. Medicaid Program Classification

The Medicaid program classification code is MQB-E. D. Coverage Coverage for QI1/MQB-E is the same as for MQB-B. The only benefit is payment of the Part B Medicare premium. No Medicaid card is issued.

E. Retroactive Coverage

Like MQB-B, QI1/MQB-Es can be authorized for retroactive coverage for up to 3 months prior to the month of application. However, coverage can never be authorized for a period prior to January of the current year.

F. No Dual Eligibility

Unlike MQB-Q and MQB-B, a QI1/MQB-E cannot be dually or otherwise eligible for Medicaid. This means an:

1. Applicant/beneficiary (a/b) authorized for Medicaid in any other program (MAABD, SAAD, MAF, etc.) is not eligible for QI1/MQB-E, and

2. A/b whose application is pending to meet a deductible is not eligible for QI1/MQB-E, and

3. Ongoing beneficiary placed in deductible status is not eligible for QI1/MQB-E unless the a/b elects to change coverage solely to QI1/MQB-E.

G. Processing Requirements

1. The application processing standard is 45 days.

2. QI1/MQB-E is subject to monitoring. Refer to MA-2305, Evaluating County/DDS Performance.

H. Ongoing Certification Period