PM 06-14-02-a.

  1. Follow QMB procedures for processing QI-1 only applications (see WAG 06-12-02-a), except:
    1. Verify enrollment in Medicare Part A and Part B.
    2. Use the QI-1 income limit to compare countable income.
    3. Follow AABD MANG budgeting procedures for figuring countable monthly income (see WAG 15-04-03).
    4. Use Form 2382M to compare the applicant's countable income to the QI-1 income limit.
  2. If eligible for QI-1 only, approve the application through AIS or IPACS (see WAG 17-02-04 for AIS, or WAG 25-08-02-d for IPACS). Enter additional information on Form 552:
    • Item 60 - Enter the Medicare claim number. Also enter status indicator 7 after Code QMB on Line 4. Determine QI-1 eligibility date and enter it after Code QMB. QI-1 eligibility may be effective retroactive 3 months before the month of the QI-1 application, if applicant met eligibility factors during this period.

      Enter the HIB and SMIB status indicator codes and dates, if needed.