Page 91

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 September 2012 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.601 38

M0320.600 MEDICARE SAVINGS PROGRAM (MSP)

A. Introductions The Medicare Saving Program is limited Medicaid coverage for individuals who are eligible for Medicare Part A and have income and resources within specific limits. B. Covered Groups • M0320.601 QMB • M0320.602 SLMB • M0320.603 QI

M0320.601 QUALIFIED MEDICARE BENEFICIARY (QMB)

A. Policy 42 CFR 435.121 - Qualified Medicare Beneficiaries are a mandatory CN covered group. Medicaid will pay the Medicare Part A premium (as well as the Part B premium) and deductibles and coinsurance for individuals eligible as QMB only. A QMB is an individual who: • is entitled to Medicare Part A hospital insurance benefits, but not entitled solely because he/she is eligible to enroll in Part A under section 1818A of the Act (1818A is applicable to QDWI); • has resources that are within the resource limits for the Medicare Savings Programs (MSPs). See section M1110.003 for the current resource limits; and • has income that does not exceed 100% of the federal poverty level (FPL). B. Nonfinancial Eligibility . 1. Entitled to Medicare Part A The individual must be entitled to or must be enrolled in Medicare Part A. The individual does not have to be aged, blind or disabled. However, Medicare entitlement is limited to individuals who are age 65 or older, or who have received Title II social security benefits because of a disability for 24 months, or who have end stage renal (kidney) disease. Enrollment in Part A of Medicare is verified by the individual’s Medicare card, or by communication (such as SVES) with the Social Security Administration (SSA). 2. Individual Not Currently Enrolled In Medicare Part A Individuals who are not currently enrolled in Medicare Part A must apply for and enroll in Medicare Part A at the local Social Security Administration (SSA) office, and must present verification of Medicare Part A enrollment to the local department of social services (DSS) in order to be eligible for