WAG 06-12-04-b: Dual Eligibility (QMB/Medicaid)

PM 06-12-04-b

  1. Verify continued enrollment in Medicare Part A.
  2. Complete an AABD/TANF MANG Computation Sheet - Community Case (Form 2382A or Form 2383A), for community MANG cases.
    1. File Form 2382A or Form 2383A in the case record.
  3. Complete Long Term Care/Supportive Living Facility Resource Calculation (Form 2500) for long term care and supportive living facility cases.
    1. Attach Form 2500 to Form 1229.
    2. File a copy of Form 2500 in the case record.
  4. Complete Form 2382M for spenddown, long term care, and sheltered care cases with a Medicare Part A beneficiary.
    1. File Form 2382M in the case record.
  5. AABD Medical Review (Form 643C) is sent centrally to cases listed on the PAL with message "REDE FORM 643C CENTRALLY MAILED. DUE BY MM/DD/YY". The mail date printed on the REDE form is the 20th day of the calendar month in which it is printed, or the first work day following the 20th. The REDE due date is the 21st calendar day following the mail date, or the first work day following the 21st day.
    1. File Form 643C in the case record.
  6. Complete Form 157, if cancellation is needed. The notice must give the reason the action is being taken and give a policy manual reference.
    1. File Form 157 in the case record.
  7. Take action if a REDE of cash or MANG cannot be completed because the client failed to verify income or assets.
    1. Redetermine eligibility for QMB benefits if sufficient information is available.
    2. End cash and/or medical.
    3. Approve for QMB only, if eligible (see WAG 06-12-00).
    4. Report QMB REDE on Form 552 to clear PAL.
    5. Cancel case if:
      • spenddown is being ended and there's not enough information to redetermine QMB eligibility; or
      • client failed to contact Family Community Resource Center in response to request for an interview for a cash or MANG REDE and there's not enough information to redetermine QMB eligibility.