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MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD QMB Only: Customer applies November 11th. The eligibility decision is made in December. QMB coverage begins effective January 1st and ongoing. QMB and Medicaid (Dual Eligible): Applicant applies 12/3 as a state institutional case and is currently enrolled in Medicare Part A. The customer cooperates and is determined eligible as a state institutional case. Because this customer has Medicare Part A, staff must also determine whether the customer is eligible for QMB coverage. If the customer's income and resources meet QMB criteria, they will qualify for both Medicaid and QMB coverage. QMB and SSI: Applicant applies 12/3 and has $250 SSA disability income. The customer has not applied for SSI, but is probably eligible. The customer meets all the other requirements of a QMB. Request the customer apply for SSI and give the normal time limit for applying. However, once staff is able to determine the customer is eligible for QMB coverage (all verifications needed are in), the case would be approved as a QMB only case. Future action the case for the SSI information. If the customer failed to cooperate in applying for SSI, or was determined ineligible, the case would remain open as a QMB only case as long as they continued to meet the criteria. If the customer were approved for SSI, the case would be converted to an SSI case effective with the month of SSI eligibility (this could include prior med). QMB and <30 day hospital stay: Applicant applies and is approved for QMB coverage. Sometime after approval, the customer enters the hospital for seven (7) days. The case would continue as QMB and NO PATIENT LIABILITY would be determined, UNLESS the customer qualified as a state institutional case (if income is less than SSI payment level, the customer does not have to be in 30 consecutive days). If the case qualifies as a state institutional case, the case would be converted, and the customer would receive full Medicaid coverage and QMB coverage. When the customer is released from the institution, the case would be converted back to a QMB only case, allowing adverse action, as long as all requirements were still met. D-360 CASE DOCUMENTATION Staff must include in each applicant's case record facts to support the decision on the application. Documentation must be clear and concise. Provide enough information so anyone reviewing the case can determine the reason, logic and accuracy of the staff’s decisions and actions. D-355.1 MAABD APPLICATION PROCESSING Medicaid, QMB Division of Social Services Medical Assistance Manual 14 Aug 25 MTL 11/25