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Official source

Chapter 3: Household Income Rev. 8/2012 9 6) Medical Categorically Income Eligible: Medical Savings Programs (MSP) QMB, SLMB and QI

1. Case must be active or was active the month the LIEAP application was received. To verify history for all SLMB, QMB and QI-1 print the ongoing history screen from SS09. Screen shot 1 2. Determine if all members of the household are receiving the same type of medical assistance, ie. 2 QMB, 2 SLMB.

In SS09 verify case history. Print the (alt 1) screen . This is the case history

Print form 271 Medicare Savings Program Worksheet from File Director, under Economic Assistance and under “Current” category.

The 271 medical form benefit date cannot be more than 12 months old. If the form is for 3/12 and you are processing an application from 5/13 you would not be able to use the 271 Medical form. Either the household is no longer getting the medical savings or they are now on SS09 Medical Savings which the income is then verified on SS09. The history must show case is ongoing or was active the month the LIEAP application was received.

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Page 20

Official source

Chapter 3: Household Income Rev. 8/2012 9 6) Medical Categorically Income Eligible: Medical Savings Programs (MSP) QMB, SLMB and QI

1. Case must be active or was active the month the LIEAP application was received. To verify history for all SLMB, QMB and QI-1 print the ongoing history screen from SS09. Screen shot 1 2. Determine if all members of the household are receiving the same type of medical assistance, ie. 2 QMB, 2 SLMB.

In SS09 verify case history. Print the (alt 1) screen . This is the case history

Print form 271 Medicare Savings Program Worksheet from File Director, under Economic Assistance and under “Current” category.

The 271 medical form benefit date cannot be more than 12 months old. If the form is for 3/12 and you are processing an application from 5/13 you would not be able to use the 271 Medical form. Either the household is no longer getting the medical savings or they are now on SS09 Medical Savings which the income is then verified on SS09. The history must show case is ongoing or was active the month the LIEAP application was received.