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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 168 Chapter 1 Application/Redetermination Process

1.16 QUALIFIED MEDICARE BENEFICIARIES (QMB), SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLIMB), AND QUALIFIED INDIVIDUALS (QI-1) QMB, SLIMB and QI-1 are Medicare Premium Assistance (MPA) programs. 1.16.1 APPLICATION FORMS The DFA-QSQ-1 is the primary application to apply for QMB. SLIMB or QI-1. No DFA-R/R-1 is required when using this form. Additional ways a client can apply for the Medicare Premium Assistance (MPA) programs, also see section 1.3: • WV PATH is the client portal where a client can apply for all benefits. Depending on how the client applies on the site, WV PATH may not collect asset information. Worker may need to have the client complete the DFA-SLA-S1 to collect asset information. • The DFA-2 • The SLA-1 with the SLA-S1 • The SLA-2 with the SLA-S1 • The DFA-MA-1 can be used to apply for MPA programs when the client is also applying for Long Term Care Medicaid.

When Low Income Subsidy (LIS) files are received from the Social Security Administration (SSA), applicants who are not current Medicaid Premium Assistance clients are issued a DFA- QSQ-1 through the eligibility system.

Note: Clients who are eligible for SSI, and entitled to premium-free Medicare Part A and/or enrolled in Medicare Part B, are deemed eligible for Qualified Medicare Beneficiary (QMB) coverage without an application. This coverage is established from a monthly batch program, a data exchange, or from other sources. The SSI and Deemed QMB coverages will be received dually in the eligibility system.