Revision 14-2; Effective June 1, 2014

 

A-8100 Qualified Medicare Beneficiary (QMB)

Revision 11-4; Effective December 1, 2011

 

QMBs are entitled to Medicare Part A (either with or without payment of premiums) with income usually counted according to the SSI rules at or below the federal poverty guidelines. States determine QMB eligibility, and Medicaid pays all Medicare-related expenses for QMBs (premiums, deductibles and coinsurance). Many SSI beneficiaries meet the QMB eligibility factors. Persons may be eligible under both a Medicaid or Community Attendant Services program and the QMB program (Public Law 100-360). For more information on the QMB program, see Section Q-2000, Qualified Medicare Beneficiaries (QMB) – MC-QMB.

Automated System Program Identifier
TIERS – MC-QMB

 

A-8200 Specified Low-Income Medicare Beneficiaries (SLMB)

Revision 13-4; Effective December 1, 2013

 

Persons eligible for this program do not receive regular Medicaid benefits. Medicaid will pay the Medicare Part B premiums for SLMB. The person must be entitled to enroll in Medicare Part A and must meet all of the eligibility requirements for QMB status, except for income less than 120 percent of the federal poverty level. Persons may be eligible under both a Medicaid or Community Attendant Services program and the SLMB program (see Section 4501(b) of the OBRA, 1990). For more information on the SLMB program, see Section Q-3000, Specified Low-Income Medicare Beneficiaries (SLMB) – MC-SLMB.

Automated System Program Identifier
TIERS – MC-SLMB

Note: For TIERS, the following programs cannot be dually eligible for SLMB: ME-Pickle; ME-SSI Prior; ME-Temp Manual SSI; ME-SSI; ME-Disabled Adult Child (DAC); MC-SLMB; MC-QMB; and ME-A and D Emergency. Even though ME-Pickle and ME-DAC recipients may meet SLMB eligibility requirements, the Medicare Part B premium is already paid by the state of Texas based on their prior SSI eligibility and the continuation of that Medicaid coverage. The only requirement to test for SLMB is if the Pickle or DAC eligibility will be denied.

 

A-8300 Qualifying Individuals (QIs)

Revision 14-2; Effective June 1, 2014

 

Persons eligible for this program do not receive regular Medicaid benefits. QIs must meet the eligibility criteria for the Qualified Medicare Beneficiary (QMB) Program, except the income limits are higher. Medicaid will pay the Medicare Part B premiums for QIs. These persons must be entitled to be enrolled in Medicare Part A and have countable income of at least 120 percent but less than 135 percent of the current federal poverty level. Eligibility is determined for each calendar year.QI recipients cannot be certified under any other Medicaid-funded program and receive QI benefits simultaneously (Public Law 105-33, Balanced Budget Act of 1997). For more information on the QI program, see Section Q-5000, Qualifying Individuals (QIs).

Automated System Program Identifier
TIERS – MC-QI-1

Note: Even though ME-Pickle and ME-Disabled Adult Child (DAC) recipients may meet QI-1 eligibility requirements, the Medicare Part B premium is already paid by the state of Texas through the Pickle or DAC Medicaid program eligibility. The only requirement to test for QI-1 is if the Pickle or DAC eligibility will be denied.

 

A-8400 Qualified Disabled Working Individuals (QDWI)

Revision 14-2; Effective June 1, 2014

 

Persons eligible for this program do not receive regular Medicaid benefits and must be disabled working individuals entitled to Medicare Part A (hospital coverage). Medicaid will pay the Medicare Part A premiums for QDWIs. These persons must be entitled to enroll in Medicare Part A, not otherwise certified under any other Medicaid-funded program, have countable income of no more than 200% of the federal poverty guidelines, have countable resources of no more than twice the SSI resource limit and be referred by SSA (Public Law 101-239, OBRA 1989). For more information on the QDWI program, see Section Q-6000, Qualified Disabled and Working Individuals (QDWI) – MC-QDWI.

Automated System Program Identifier
TIERS – MC-QDWI