QI-1 can be certified effective three months prior to the month of application, if all factors of eligibility were met all three months.

For additional information regarding factors of eligibility for QI-1, refer to article ABD: Qualified Individuals – Group 1 (QI-1).

If all factors of eligibility were NOT met prior to month of application, then only certify effective the month of application.

NOTE: Cases that were previously or are currently used for active TANF benefits should not be used for ABD and buy-in benefit cases.

Hiram Grant applied for help with his Medicare premiums on 08/23/2018. His Medicare coverage started in 04/2018. His monthly income is RSDI of $1365. His only resource is a bank account. She brought in bank statements that show the following balances:

August-$3652
July-$3498
June-$3512
May-$3602

He met eligibility for all three months. The current month’s bank balance will be coded in FACS (all the balances will be listed in case notes).

Household tab:

• Benefit: Qualifying Individuals Group 1
• Status: Added to Benefit
• Effect Date: 05/01/2018

Income tab:
RSDI

• Declared Monthly Amt (FSS-1): $1365
• How Often Paid: Monthly
• Receiving: Click for “yes”
• Countable Amt (PS2): $1365
• SSN Claim Number: 999957957A

Resource tab:

• Does anyone have any liquid resources or assets? Click once for “yes”
• Liquid Resource Type: Checking
• Balance: $3652
• Where Located: Bank of Indio
• Account Number: 444555777

PS2 blocks

• Resource Type: Savings which include cash, bank accounts, bonds, stocks, etc.
• Countable Amt: $3652

TPL tab:

• Is anyone covered by medical insurance? (Medicare, CHAMPUS and VA Aid and Attendance are considered insurance): click once for “yes”
• Has anyone been in an accident in the last 12 months? Click once, if “Yes”. Click twice if “no”.

Medical General tab:

• Type Action Taken: Certified or Online Enrollment
• Reason: Select appropriate reason
• Application Date: 08/23/2018
• Certification/Disposition Date: 05/01/2018
• Certification Period: 12 (Buy-in won’t work if this is anything other than “12”)
• Effective Months: 99
• Adv Notice Req: No
• Date of Last Redetermination: 05/01/2018 (must match Cert date)

Medical Financial tab:

• Medical Application Reason: SSP or Disability has already been established with SSA
• Medical Application Source: CO- County Office