Q-2800, Ensuring Continuous QMB

Revision 24-3; Effective Sept. 1, 2024

When a person loses eligibility for SSI and applies for Medicaid, verify if they were receiving QMB benefits at the time of SSI denial by reviewing:

If the person was receiving SSI and QMB and is eligible for ongoing QMB after the SSI termination, the effective begin date for QMB benefits is the day immediately following the SSI termination date. This ensures continuous QMB coverage.

Examples:

  • The last day of SSI and QMB coverage is Jan. 31st. The person is eligible ongoing for ME-Pickle and MC-QMB. The effective begin date for ongoing MC-QMB is Feb. 1st.
  • The last day of SSI and QMB coverage is Jan. 31st. The person is eligible for MC-QMB. The effective begin date for ongoing MC-QMB is Feb. 1st.

Though there is no limit to how far back continuous QMB coverage may be granted, system limitations will not allow Medicare Part B buy-in reimbursement to start any earlier than two full fiscal years before the date the buy-in process is successfully completed.  Note: The fiscal year begins in September for this purpose.

Examples:

  • SSI with QMB was terminated Dec. 31, 2017. The person applies for QMB on April 7, 2020. Continuous QMB is approved on May 15, 2020. The continuous QMB effective date is Jan. 1, 2018, but the buy-in process is not completed until July 15, 2020.
    Buy-in is effective January 2018. The current fiscal year began September 2019 and the prior two fiscal year period began September 2017.
  • SSI with QMB was denied Dec. 31, 2017. The person applies for QMB on Aug. 15, 2020 and is approved for continuous QMB on Sept. 11, 2020. The QMB effective date is Jan. 1, 2018, but buy-in process is not completed until Nov. 15, 2020.
    Buy-in is effective September 2018. The current fiscal year began September 2020 and the prior two fiscal year period began September 2018.
     

Buy-in is effective September 2018. The current fiscal year began September 2020 and the prior two fiscal year period began September 2018.

What is not considered Continuous QMB:

  • QMB recipient was denied in error because income was incorrectly counted in the budget. The case must be corrected to add the missing coverage the recipient is entitled to receive.
  • QMB recipient was correctly denied for exceeding the income or resource limits. This is a valid denial and a break in coverage. At reapplication, continuous QMB does not apply. The QMB effective date is the first of the month after disposition.
  • QMB recipient was denied because the redetermination packet was lost or misrouted in the task list manager queue. The case must be corrected to add the missing coverage the recipient is entitled to receive.
  • QMB recipient was denied at redetermination for failure to return a renewal form. This is a valid denial. At reapplication, the QMB effective date is the first of the month after disposition.

Continuous QMB for Medicare Part B-ID Recipients

Ensure continuous QMB coverage if the person was receiving regular QMB coverage one month and is eligible for Part B-ID QMB the following month.