DATE: February 21, 2003
SUBJECT: MQB-E/Qualifying Individuals (QI1) Update and Certification Period Extension For April 2003
DISTRIBUTION: County Directors of Social Services
Medicaid Eligibility Staff
The Balanced Budget Act of 1997 established a mandatory eligibility group of low income Medicare beneficiaries. The funding for this group, the Qualifying Individuals (QI1/MQB-E), was based on a fixed allocation at 100% Federal Financial Participation (ffp) through December 2002.
A series of continuing resolutions have been issued to extend the QI1 program at its present funding level. The latest one continues the funding through April 2003. Congress may take action to continue funding the QI1 program past April 2003, but what action will be taken is unknown at this time.
The night of February 26, 2003, eligibility in EIS for existing MQB-E cases is being extended automatically through April 30, 2003.
The purpose of this letter is to outline new procedures involving MQB-E eligibility. Also, beginning February 27, 2003, you must authorize eligibility through April 30, 2003 for MQB-E approvals of applications taken prior to January 1, 2003, if the person continues to be eligible for MQB-E. Follow these instructions until you receive a subsequent administrative letter regarding what will happen next with the MQB-E program.
The exclusion of the RSDI cost-of-living allowance (COLA) ends with the implementation of the new income limits. Begin counting the full RSDI amount, including the 2003 COLA effective April 1, 2003. Continue to disregard the COLA for January, February, and March 2003. The ABD manual will be updated in the near future with the new amounts and implementation instructions. We are in the process of modifying EIS to allow Medicaid Classification changes and aid program/category transfers to MQB-E.
There may be individuals receiving MQB-E who are no longer qualified. For MQB-E, pull the cases listed on the report in XPTR: 'DHREJA POV POT ELIG FOR PROG REV' and complete an SOLQ to verify the RSDI amount. Compare the income with the new MQB-E income limit.
React to the change in the case by the pull cutoff date in April. If the poverty level increase causes ineligibility for MQB-E, send a timely notice. Evaluate for Medicaid under all other aid program/categories. Refer to MAABD Change Notice No. 19-03 for detailed instructions regarding the poverty level increase.
There may be recipients in other aid program/categories who may qualify for MQB-E. We are in the process of modifying EIS to allow Medicaid Classification changes and aid program/category transfers to MQB-E. Place the individuals on the MQB-E waiting list as instructed in DMA Administrative Letter No. 14-03, Addendum 1. Use the same list you have been using to track other individuals potentially eligible for MQB-E since January 1, 2003. We will issue further instructions in early March, 2003.
If a recipient ceases to be eligible for MQB-B due to countable income exceeding the income limit and would be eligible for MQB-E, leave the MQB-B case active. Do not terminate the MQB-B case.
If a recipient ceases to be eligible for MAABD or MQB-Q and would be eligible for MQB-E, send a manual timely notice to notify the individual he is no longer eligible for MAABD or MQB-Q. Do not key a DSS-8125 to terminate.
This has not changed. Do not take applications. Continue to place these individuals on the MQB-E waiting list as instructed in DMA Administrative Letter No. 14-03, Addendum 1.
EIS automatically will extend the certification through date for MQB-E cases to April 30, 2003. This update will occur the night of February 26, 2003. A list of the cases that are updated will be available the next day in a report on XPTR. The XPTR name is “DHREJ QI1 Cert Period Extended”. Select the version dated 2/26/2003 to view this list.
MQB-E cases with an 8125 pending the day the certification period extension runs will not be included in the automatic update. Also, MQB-E cases that do not have a certification through date of 3/31/2003 will not be updated. These cases will require manual update of the certification period if the case remains active MQB-E. DMA will notify counties of cases requiring manual updates.
If you have questions, please contact your Medicaid Program Representative.
Nina M. Yeager
[This material was researched and prepared by Mary Spivey, EIS Consultant, Medicaid Eligibility Unit.]
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.