QMBP is first and foremost a medical program. Someone who has income or resources above the SSP but under the QMBP standards should be certified for the medical benefit, even if that person is not on Medicare. This example will show how to certify someone on Medicare who has a medical bill from three months ago.

When the applicant is not on Medicare, s/he will only be added to the medical benefit in the Household tab in FACS.

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

Andrew Johnson is applying for medical and buy-in. He has been receiving Social Security-Disability since 07/2016. He had a stroke on 06/23/2018. He went on Medicare in 07/2018. He turned in an application with AFS on 09/05/2018. His Social Security benefit letter shows he started receiving $1002 in January, 2018. He has one vehicle, a 1996 Audi A6 with a trade-in value of $530, (which is exempt if it is used for transportation of the individual or a member of the individual’s household): He has one checking account. He requested help with the June medical bill so he was asked for bank statements back to June. The balances on those statements were:

• June 1: $1865
• July: $5
• August: $63

He meets the income and resource standards back to June.

• Add to the medical benefit for 06/01/2018 to cover the medical bill.
• REMEMBER! Client is added to QMB for buy-in the month after the one in which eligibility was determined. Eligibility was determined in September so the earliest Andrew can be added to QMB is 10/01/2018.
  

RSDI-$1002

• He receives RSDI so the Social Security Claim number from BENDEX must be entered into the SSN Claim Number Block – 999997997A
  
• The bank balances should all be entered into case notes. Since he was under the resource standard all three months, we will just enter the most recent statement’s balance (August) into FACS.
  
• Check the box showing he has medical insurance. Medicare policy information is not entered into the bottom of the TPL tab.
  
• In the Medical tab, choose “yes” for the question “Does this person want medical services?”
  
• Certified or Online Enrollment Sent to OHCA
• Application Date: 09/05/2018
• Certification Date: 06/01/2018 (to cover the June medical bill)
• Certification Period: must be 12 or buy-in won’t work
• Date of Last Redetermination: 06/01/2018 (must be same as Certification Date)
• Categorical Relationship Indicator: Disabled (Categorically Needy-Related to Disabled)
  
• Medical Application Reason: (A Disability Determination Has Already Been Made By SSA) (This will give 60 days from the app date to complete the case action)
• Medical Application Source: CO-County Office
  

Note: Someone related by age, blind, disability (even by death) can request a case be certified three months prior to the month of application. Refer to policy 317:35-7-60(b) and policy 317:35-5-4.(1)(H)

Refer to article ABD: How to Code for Eligible Individual with Ineligible Spouse (Short Term Medical) for instances where there is a spouse.