WAG 06-14-03: Family Community Resource Center Approval

PM 06-14-03

1. (CO) Verifies Medicare Part A and Part B enrollment through BENDEX.
2. (CO) Generates monthly list, called "Potential QI-1 Eligible Cases", of cases with Item 90 income of more than $25 plus QI-1 income limit for a single person. List shows cases which Family Community Resource Center must review.

   Cases are listed: 

   • for Category 91, 92, and 93 cases, when Code HIB status indicator 4 is centrally added in Item 60, no SMIB status indicator appears, and a Code HIB status indicator did not previously appear; and
   • when Code 390 SPD appears in Item 80.

     The list shows the: 

   • case name,
   • case ID number,
   • RIN, and
   • total income amounts from Item 90.
3. (FCRC) Use Form 2382M to decide if monthly countable income is within QI-1 income limit.

   NOTE: Spenddown clients are QI-1 eligible if they have income above SLIB income limit, but at or below QI-1 limit. Spenddown enrollment shows that other QI-1 eligibility requirements are met. 

4. (FCRC) Complete Form 552 when the applicant is QI-1 eligible:

   Item 3	-TA 31
   Item 33	-TAR 41
   Item 60	-Social Security/Medicare Claim Number or Railroad Retirement Claim Number. Enter MM/YY of QI-1 eligibility and status indicator 3 following code QMB. QI-1 eligibility may be effective 3 months before application.

5. (FCRC) Send QI-1 eligible applicant or caretaker the Notice Regarding Medicaid Payment of Medicare Part B Premiums (Form 3420).

   NOTE: Send Form 3420 to each client converted to QI-1 status by the Family Community Resource Center, whether or not they appear on "Potential QI-1 Eligible Cases" list.