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West Virginia Income Maintenance Manual Chapter 10

West Virginia Income Maintenance Manual Page 66 Chapter 10 The Case Maintenance Process

10.15 QMB, SLIMB, AND QI-1 10.15.1 QUALIFIED MEDICARE BENEFICIARIES (QMB) When a client is dually eligible for Qualified Medicare Beneficiary (QMB) coverage and a full Medicaid coverage group, both benefits are issued under the full Medicaid coverage group case number. Continuing eligibility for both benefits must be determined separately when a change is reported. • If the client remains eligible for both benefits, the full Medicaid coverage group assistance group (AG) is updated in the eligibility system to reflect the current case information. • If the change results in a spenddown in the full-coverage Medicaid AG and the client remains eligible for QMB, the QMB coverage must continue uninterrupted. • If the client is ineligible for QMB, the coverage is discontinued after advance notice. 10.15.2 SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLIMB) When a client is dually eligible for Specified Low-Income Beneficiaries (SLIMB) coverage and a full Medicaid coverage group, both benefits are issued under the full Medicaid coverage group case number. Continuing eligibility for both benefits must be determined separately based on the changed case circumstances. • If the client remains eligible for both benefits, the full Medicaid coverage group case is updated in the eligibility system to reflect the current case information. • If the change results in a spenddown in the full Medicaid case and the client remains eligible for SLIMB, the SLIMB benefit must continue uninterrupted. • If the client is ineligible for SLIMB, the benefit is discontinued after advance notice. 10.15.3 QUALIFIED INDIVIDUALS (QI-1) When a client is eligible for QI-1, he must not be eligible for a full-coverage Medicaid group. When a QI-1 client has an increase in income, there is no provision that his benefits must