WAG 06-24-03

new textAPPROVALS

An HBWD case (except one with a zero premium) is approved through the Client Information System (CIS) as "enrolled", similarly to unmet spenddown. The case stays in "enrolled" status until the monthly premium is paid for the first month. At that point, the case status is changed to active, and the participant starts receiving HBWD benefits.

QMB OR SLIB ELIGIBILITY

Initial eligibility for QMB only or SLIB only will not be determined by HBWD. HBWD will include QMB or SLIB eligibility when approving an HBWD case. HBWD participants are not eligible for QI-1.

Persons with QMB and SLIB, who fail to pay their HBWD premium, will continue to receive assistance with Medicare cost sharing expenses as QMB or SLIB. These cases will be transferred to the DHS FCRC by the HBWD Unit.

DENIALS

HBWD uses the AABD denial process. Refer to PM 17-04-02 and WAG 17-04-02.

Form HFS 458MB1 is mailed when the application is denied.