Page 94

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2017 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.601 41

Cancel the enrollee’s full coverage effective the last day of the month, using cancel reason “007." Reinstate the enrollee’s coverage with the begin date as the first day of the month following the cancellation effective date. The AC is QMB-only. 3. QMB Becomes Eligible For Full Coverage When an enrolled QMB-only becomes eligible in another covered group which has full Medicaid coverage, except when he/she meets a spenddown, e.g., a QMB-only individual’s resources change to below the MN limits: • cancel the QMB-only coverage effective the last day of the month immediately prior to the month in which he/she became eligible in the full coverage covered group, using cancel reason “024"; • reinstate the enrollee’s coverage with the begin date as the first day of the month in which he/she became eligible in the full coverage covered group, with the appropriate full coverage AC. 4. Spenddown Status At application and redetermination, eligible QMBs who meet an MN covered group and who have resources that are within the lower MN resource limits are placed on two 6-month medically needy spenddowns. All spenddown periods are based on the application or renewal date, as appropriate. See M1370. In order to be placed on spenddown, QMBs with end-stage renal disease must meet a medically needy covered group. 5. QMB Meets Spenddown When an eligible QMB meets the spenddown, cancel the QMB-only coverage effective the day before the spenddown was met, using cancel reason “024". Reinstate the enrollee’s coverage with the first date the spenddown was met as the begin date of coverage, and enter the end date of the spenddown period as the end date of coverage. The aid category is medically needy dual-eligible: • 028 for an aged MN individual also eligible as QMB; • 048 for a blind MN individual also eligible as QMB; • 068 for a disabled MN individual also eligible as QMB. 6. Spenddown Period Ends After the spenddown period ends, reinstate the QMB-only coverage using the appropriate QMB-only AC. The begin date of the reinstated coverage is the first day of the month following the end of the spenddown period, and the application date is the date of the original application used to determine the initial QMB eligibility.