Revision 13-4; Effective December 1, 2013

 

Q-4100 SLMB Dual Eligibility and Medicare Buy-In

Revision 13-4; Effective December 1, 2013

 

Programs ME-Pickle, ME-SSI Prior, ME-Temp Manual SSI, ME-SSI, ME-Disabled Adult Child, MC-QMB, and ME-A and D-Emergency cannot be dually eligible for SLMB. Even though ME-Pickle and ME-Disabled Adult Child recipients may meet SLMB eligibility requirements, the Medicare Part B premium is already paid because they are on Medicaid.

 

Q-4200 Texas Works Medicaid and QMB or SLMB Dual Eligibility

Revision 13-3; Effective September 1, 2013

 

Persons receiving Medicaid benefits through Texas Works Medical Programs also may qualify for QMB benefits.

These programs include the following:

  • MA – Deceased Prior Medical (TPDE)
  • MA – Earnings Transitional (TP 07)
  • MA – Historical Prior Medical (TPPM)
  • MA – EID Transitional (TP37)
  • MA – TANF Level Families (TP08)
  • MA – Pregnant Women (TP 40)
  • MA – Children Under 1 (TP 43)
  • MA – Newborn Children (TP 45)
  • MA – Children 1-5 (TP 48)
  • MA – Children 6-18 (TP 44)

The above programs cannot be dually eligible for SLMB. Even though these programs may meet SLMB eligibility requirements, the Medicare Part B premium is already paid. An exception is MA – Medically Needy Spend Down Program (TP-56) and is the only TW medical program eligible for SLMB dual eligibility.

Remember there is no prior coverage for QMB unless income during a specific prior month is over the QMB limit and is within the SLMB income limit criterion.

 

Q-4210 Breast and Cervical Cancer Services Program

Revision 12-2; Effective June 1, 2012

 

Do not certify a person for a Medicare Savings Program if that person is receiving services through the Breast and Cervical Cancer Services (BCCS) program.

To receive services through the BCCS program, a person must be uninsured. As a result, insurance coverage from another Medicaid program or Medicare would stop that person from receiving services through the BCCS program.

The MSP EDG will be pended until MBCC denial is disposed by the TW advisor. The TW advisor will be notified of the pended MSP EDG by an Alert.

 

Q-4220 Reserved for Future Use

Revision 12-2; Effective June 1, 2012

 

 

Q-4230 TANF with QMB

Revision 16-3; Effective September 1, 2016

 

If the person is eligible for QMB, the Your Texas Benefits Medicaid ID Card will indicate the coverage as well as regular Medicaid benefits through a Category 2 – TANF program. The person presents the Your Texas Benefits Medicaid ID card to obtain prescription drugs and other Medicaid-only benefits each month. The Your Texas Benefits Medicaid ID Card is used to obtain all other benefits covered under Medicaid/Medicare.

 

Q-4240 Reserved for Future Use

Revision 12-2; Effective June 1, 2012

 

 

Q-4250 Reserved for Future Use

Revision 12-2; Effective June 1, 2012