Long Term Care (LTC): Medicaid Programs and QI-1

The QI-1 Program assists individuals by paying for their Medicare premiums, provided the following conditions exist:

  • The individual is enrolled for Medicare hospital insurance benefits under Part A, which includes an individual entitled to hospital insurance benefits by reason of voluntary enrollment in the premium-paying Part A program.
  • The individual’s income and resources do not exceed the standard as shown on DHS Appendix C-1, Schedule VII.A for QI-1. For an individual whose spouse is not eligible for Medicare, total countable income of the eligible individual must be equal to or less than the QI standards for an individual and the income of both must be equal to or less than the QI standards for a couple. For a couple who are both eligible for Medicare, total countable income must be equal to or less than QI standards for a couple.
  • A Qualifying Individual cannot be otherwise eligible for Medicaid. Therefore, unlike QMB and SLMB individuals who may be determined eligible for Medicaid benefits in addition to their QMB/SLMB benefits, a QI recipient cannot be receiving or eligible for any other type of Medicaid benefit.

The programs of ADvantage, Nursing Facility Care, other Home-Based Community Waiver Services, as well as State Plan Personal Care are Medicaid benefits. For this reason, an individual cannot be receiving Medicare premium assistance through the QI-1 program while receiving Long Term Care benefits. Their income/resources would have to fall under the guidelines of QMB/SLMB for Medicare premium assistance

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