PM 06-12-03-b

  1. (CO) Generates a monthly list called "Potential Medicaid/QMB Eligible Cases". The list contains Part A community spenddown cases (Code 390 SPD in Item 80) that have Item 90 income amounts applying to the Medicaid case exceeding $25 plus the QMB income limit for a single person. Cases are listed when:
    • Status indicator Code 4 is centrally added in Item 60 following Code HIB and a status indicator did not previously appear;
    • Code 390 SPD appears in Item 80; and/or
    • the amount following Item 80 Code 392 is $2,001 or greater.

      The list shows the:

    • case name,
    • case ID number,
    • RIN,
    • total income amounts from Item 90, and
    • month/year of the last month of the 12-month enrollment period.
  2. (FCRC) Prioritize cases on the list.
    1. (FCRC) Review cases due for the earliest central cancellation, to avoid cancellation of potential QMB cases.
    2. (Client) Files Application for Medical Assistance - Short Form (Form 2431) after their case has been centrally canceled, but before QMB eligibility has been determined.
    3. (FCRC) Determine QMB eligibility when processing Form 2431.
  3. (FCRC) Review cases not centrally approved for QMB that are not on the list, but are potentially eligible for QMB.
  4. (FCRC) Complete Form 2382M to decide if countable monthly income and nonexempt assets are within the QMB income and asset limits.
  5. (FCRC) Approve QMB if eligible (see WAG 06-12-02-a).
  6. (FCRC) Send client Form 3132 to tell about QMB eligibility.