Revision 19-2; Effective June 1, 2019

 

The Qualifying Individuals (QIs) program is an extension of QMB.

A person is not eligible for QI coverage if the person:

  • is in the custody of penal authorities, or
  • is over age 20 and under age 65 and resides in an institution for mental diseases (IMD).

A person cannot be certified under any other Medicaid-funded program and have QI coverage at the same time. Persons must be given the opportunity to choose which benefit they prefer to receive.

Because persons cannot receive both Medicaid and QI benefits at the same time, document the person's oral or written choice of preferred benefit in the comments section, including a choice between QI and Community Attendant Services (CAS) benefits.

Note: ME-Pickle and ME-Disabled Adult Child recipients will not have to choose, as the Medicare Part B premium is already paid because they are on Medicaid.

 

Q-5100 QI Benefits

Revision 09-4; Effective December 1, 2009

 

Authorized under 42 U.S.C. §1396a(a)(10)(E)(iv), the QI Program pays only Medicare Part B premiums to a person who is eligible for QI.

 

Q-5200 QI Income Limit

Revision 19-2; Effective June 1, 2019

 

To be eligible for QI coverage, a person must meet the eligibility criteria for QMB, except the person must have income that is at least 120 percent but less than 135 percent of the federal poverty level.

Monthly Income Limits
QI-1s Individuals
(income at least, but less than)
Couples
(income at least, but less than)
Deeming
March 1, 2019 to Present $1,249.01 to $1,406 $1,691.01 to $1,903 $497
March 1, 2018 to Feb. 28, 2019 $1,214 to $1,366 $1,646 to $1,852 $486
March 1, 2017 to Feb. 28, 2018 $1,206 to $1,357 $1,624 to $1,827 $470
March 1, 2016 to Feb. 28, 2017 $1,188 to $1,337 $1,602 to $1,803 $466
March 1, 2015 to Feb. 29, 2016 $1,177 to $1,325 $1,593 to $1,793 $468
March 1, 2014 to Feb. 28, 2015 $1,167 to $1,313 $1,573 to $1,770 $457
March 1, 2013 to Feb. 28, 2014 $1,149 to $1,293 $1,551 to $1,745 $452
Mar 1, 2012 to Feb. 28, 2013 $1,117 to $1,257 $1,513 to $1,703 $446
March 1, 2011 to Feb. 29, 2012 $1,089 to $1,226 $1,471 to $1,655 $429
March 1, 2009 to Feb. 28, 2011 $1,083 to $1,219 $1,457 to $1,640 $421
March 1, 2008 to Feb. 28, 2009 $1,040 to $1,170 $1,400 to $1,575 $405
April 1, 2007 to Feb. 29, 2008 $1,021 to $1,149 $1,369 to $1,541 $392
April 1, 2006 to March 31, 2007 $980 to $1,103 $1,320 to $1,485 $382
April 1, 2005 to March 31, 2006 $957 to $1,077 $1,283 to $1,444 $367
April 1, 2004 to March 31, 2005 $931 to $1,048 $1,249 to $1,406 $358
April 1, 2003 to March 31, 2004 $898 to $1,011 $1,212 to $1,364 $353
April 1, 2002 to March 31, 2003 $886 to $997 $1,194 to $1,344 $347
April 1, 2001 to March 31, 2002 $859 to $967 $1,161 to $1,307 $340
April 1, 2000 to March 31, 2001 $835 to $940 $1,125 to $1,266 $326
May 1, 1999 to March 31, 2000 $824 to $927 $1,106 to $1,245 $318
Jan 1, 1998 to April 30, 1999 $805 to $906 $1,085 to $1,221 $315

QI uses the same resource limits as QMB (see Section Q-2500, QMB Income and Resource Limits). See Appendix XXXI, Budget Reference Chart.

 

Q-5300 QI Cost-of-Living Adjustment

Revision 12-2; Effective June 1, 2012

 

For QI eligibility, the cost-of-living adjustment (COLA) in Social Security benefits is excluded for the months of January and February. To determine eligibility for applications and redeterminations, use the pre-COLA benefit amount during those months.

This income exclusion applies only to eligibility for QMB, SLMB and QI. For QMB, SLMB and QI eligibility, the RSDI Title II COLA is excluded during a transition month until the publication of the federal poverty level (FPIL). Based on federal law codified in 42 USC 1396d(p)(2)(D)(ii), transition month means each month in a year through the month following the month in which the annual

Revision of the FPIL is published. If the federal publication of the FPIL is available in March, the transition months would include January, February and March. If the federal publication of the FPIL is available in February, the transition months would include January and February.

For years after 1998 through 2007, the exclusion of the Social Security COLA for January through March applies. Beginning in 2008, the exclusion of the Social Security COLA for January through February applies.

Reference: See Chapter E, General Income, for deeming of income.

Reminder

QI-1 persons cannot be eligible for regular Medicaid and QI-1 benefits at the same time. Always give applicants the opportunity to choose which benefit they prefer to receive and document the person's verbal or written choice of preferred benefit, including a choice between QI-1 and CAS benefits. For QI-1, the three months prior period cannot extend back into the previous calendar year. The application file date and prior coverage months must be in the same calendar year.

Example

February is the application month, which makes January the only possible prior coverage month.

 

Q-5400 QI Medical Effective Date

Revision 09-4; Effective December 1, 2009

 

Eligibility for QI coverage is determined for each calendar year. A person's QI eligibility may begin with the month of application. A person with QI coverage is eligible for three months prior medical coverage if all criteria are met. The three-month prior period cannot extend back into the previous calendar year.

The application file date and prior coverage months must be in the same calendar year. Example: If the application is filed in February, the only possible prior coverage month is January.

 

Q-5500 Reserved for Future Use

Revision 12-2; Effective June 1, 2012

 

 

Q-5600 QI-2

Revision 12-2; Effective June 1, 2012

 

Authority for the QI-2 program under Public Law 105-33 expired on Dec. 31, 2002.