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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 M0320.604 52

2. Enrollee’s AC Changes To QDWI An enrolled enrollee’s AC cannot be changed to AC “055” using a “change” transaction in VaCMS. If a Medicaid enrollee becomes ineligible for full- coverage Medicaid, but is eligible as a QDWI, 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 Part A premiums as a QDWI. Cancel the enrollee’s full coverage effective the last day of the month, using cancel reason “007.” Reinstate the enrollee’s coverage as QDWI with the begin date as the first day of the month following the cancellation effective date. AC is “055.” 3. QDWI’s AC Changes To Full Coverage AC When an enrolled QDWI becomes eligible in another covered group which has full Medicaid coverage (except when he/she meets a spenddown); e.g., he/she is no longer able to work and starts to receive SSA and SSI disability benefits: • cancel the QDWI 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 Eligible QDWIs who meet an MN covered group and who have resources that are within the lower MN resource limits are also placed on two 6-month medically needy spenddowns. 5. QDWI Meets Spenddown When a QDWI meets a spenddown, cancel his AC “055" coverage effective the date before spenddown was met using cancel reason “024.” Reinstate coverage as medically needy beginning the day the spenddown was met and ending the last day of the spenddown budget period. The AC is NOT dual-eligible:

• 018 for an aged MN individual NOT eligible as QMB; • 038 for a blind MN individual NOT eligible as QMB; • 058 for a disabled MN individual NOT eligible as QMB. 6. Spenddown Period Ends After the spenddown period ends, reinstate the QDWI-only coverage using the AC “055.” The begin date of the reinstated AC “055” 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 QDWI eligibility.