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Chapter 3: Household Income Rev. 8/2012 10

3. SS09 QMB, SS09 SLMB and QI-1 Categorically Eligible. Categorically eligible QMB/SLMB/QI recipients: Individuals categorically eligible for QMB/SLMB or QI will not have the medical savings worksheet (form 271) in file director. To verify active case history for SLMB, QMB and QI-1 medical case go to the SS09 system. Do a person search for each individual-the first screen (alt 1) in SS09 indicates if the case is ongoing or closed. An active case must include the month the LIEAP application was received.

SS09 active medical case history (alt 1)

The history must show case is ongoing or was active the month the LIEAP application was received. Take the unearned income and the earned income from the fields highlighted in Red X 3 and transfer the total to the application worksheet income panel under “OTHER” income.

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Page 21

Official source

Chapter 3: Household Income Rev. 8/2012 10

3. SS09 QMB, SS09 SLMB and QI-1 Categorically Eligible. Categorically eligible QMB/SLMB/QI recipients: Individuals categorically eligible for QMB/SLMB or QI will not have the medical savings worksheet (form 271) in file director. To verify active case history for SLMB, QMB and QI-1 medical case go to the SS09 system. Do a person search for each individual-the first screen (alt 1) in SS09 indicates if the case is ongoing or closed. An active case must include the month the LIEAP application was received.

SS09 active medical case history (alt 1)

The history must show case is ongoing or was active the month the LIEAP application was received. Take the unearned income and the earned income from the fields highlighted in Red X 3 and transfer the total to the application worksheet income panel under “OTHER” income.