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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL D-540.9 Division of Welfare and Supportive Services CHANGES Medical Assistance Manual KATIE BECKETT TO SSI 24 Jan 25 MTL 02/24 2. Applicant applies January and has $250 SSA disability income. The customer has not applied for SSI but is potentially eligible. The customer meets all the other requirements of a QMB.

Once the worker 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. Request the customer apply for SSI and give the normal time limit for applying.

The case would be future actioned 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 he continued to meet the criteria. If the customer were approved for SSI, the case would be converted to an SSI/QMB case effective with the month of SSI eligibility (this could include prior months).

3. 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 customer would receive full Medicaid coverage and QMB coverage for the month of hospital stay. 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 disability requirements are still met. 4. Applicant applies for medical assistance in December and is pending SSI. Eligibility is evaluated under MAGI groups and the case is approved under a MAGI group. In June SSI is approved. MAGI eligibility is terminated the next month allowing for cut-off and Medicaid under the SSI group is approved the same month MAGI eligibility ends.

D-540.10 QMB and < 30 Day Hospital Stay

1. Applicant applies and is approved for QMB coverage. Sometime after approval,

the customer enters the hospital for 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).

2. If the case qualifies as a state institutional case, the eligibility for the month of

hospitalization would be updated to reflect the full Medicaid and QMB coverage.

3. 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.