Page 93

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2019 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.601 40

3. Income The income requirements in chapter S08 must be met by QMBs. The income limits are in M0810.002. By law, for QMBs who have SSA benefits, the new QMB income limits are effective the first day of the second month following the month in which the federal poverty limit is updated. For QMBs who do NOT have SSA benefits, the new QMB income limits are effective the date the updated FPL is published. Local DSS are notified each year of the new FPL via the broadcast system. Check that system to ascertain when the SSA COLA must be counted in determining QMB income eligibility. 4. Income Exceeds QMB Limit Spenddown does not apply to the MSP income limits. If the individual’s income exceeds the QMB limit, he is not eligible as QMB and cannot spenddown to the QMB limit. Determine the individual’s eligibility in the SLMB covered group below in M0320.602. At application and renewal, if the eligible QMB individual’s resources are within the medically needy limit and the individual meets a MN covered group, place the individual on two 6-month spenddown based on the MN income limit. D. QMB Entitlement Entitlement to Medicaid coverage for QMB only begins the first day of the month following the month in which Medicaid eligibility as a QMB is determined and approved, not the month of application. See M1520.102.A.2. Because QMB coverage does not begin until the month following the month in which eligibility is determined and approved, an applicant who is eligible for QMB coverage must apply for Extra Help in order to receive the subsidy for the month of QMB approval. See chapter M20 for more information on Extra Help. Retroactive eligibility does not apply to the QMB covered group. To be eligible for Medicaid in the retroactive period, and in the application month, a QMB must meet the requirements of another Medicaid covered group. E. Enrollment 1. Aid Categories The following ACs are used to enroll individuals who are only eligible as QMBs; they do not meet the requirements of another covered group: • 023 for an aged QMB only; • 043 for a blind QMB only; • 063 for a disabled or end-stage renal disease QMB only. 2. Enrollee’s Covered Group Changes To QMB If a Medicaid enrollee becomes ineligible for full-coverage Medicaid because of an increase in income or resources, but is eligible as a QMB, the agency must send an advance notice of proposed action to the enrollee because services are being reduced. The notice must specify that he will remain eligible only for payment of Medicare premiums, deductibles and coinsurance amounts as a QMB.