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Example 1 Kate receives Social Security Disabled Child DAC benefits from Social Security. Due to other unearned income, Kate is not eligible for Special Status Medicaid as a DAC. Therefore, she is not categorically eligible for QMB even though she receives a DAC payment. 32.2.2 Entitled to Medicare A person is "entitled" to Medicare Part A or Part B-ID if they meet one of the following conditions: 1. They do not have to pay a premium for Medicare Part A and are enrolled in Medicare Part A as of the QMB determination. Example 1 Mrs. Smith applies for QMB benefits August 15. She has a Medicare card with a Part A begin date of June 1. Since Medicare will pay for Part A services as of June 1, she is "entitled" to Part A at the time of the QMB determination. 2. They must pay a monthly premium to receive Medicare Part A and meet one of the following conditions: a. They are a Medicaid member and have been enrolled in Medicare sometime in the past. In this case, the state will attempt to enroll them in Medicare Part A. QMB eligibility cannot begin prior to the Part A begin date. Example 2 Eleanor's Part A lapsed because she did not work enough quarters for free enrollment, and she could no longer afford the premiums. When she becomes eligible for Medicaid, the state will begin paying her Medicare premiums. b. They are a Medicaid member or a QMB or Specified Low-Income Medicare Beneficiary (SLMB) applicant and have never been enrolled in Medicare Part A. In this case, they must apply at the local Social Security Administration (SSA) office for Part A Medicare eligibility. The SSA office will add comments to the "Remarks" section of the application and provide a screen shot that can serve as proof of conditional Part A enrollment provided the applicant is found eligible for QMB or SLMB. SSA will provide the Part A begin date. QMB or SLMB eligibility cannot begin prior to the Part A begin date. The earliest QMB can begin is the month after the month of application. Note: For purposes of QMB or SLMB, a person can request conditional enrollment in Medicare Part A at their local SSA office at any time. They do not have to wait for the general enrollment period.

Example 3 Pearl was never enrolled in the federal Medicare system. She applies for QMB. Before she can become QMB eligible she must obtain proof of conditional eligibility for Medicare Part A. She goes to the SSA office and is conditionally determined eligible for Part A effective June 1. She applies for QMB at the IM Agency on May 1. She becomes QMB eligible as of June 1. 3. They are enrolled in Medicare Part B Immunosuppressive Drug (Part B-ID). 32.2.3 Income Limit The QMB income limit is 100% of the FPL (see SECTION 39.5 FPL TABLE). The method of counting income is based on the SSI method, not on the spousal impoverishment method (see SECTION 28.1 ADULT HOME AND COMMUNITY-BASED WAIVERS LONG-TERM CARE INTRODUCTION). Calculate QMB net income as follows: