Applications for QMB benefits must be processed within 45 days from the date of application, except in unusual circumstances. In no instance is the QMB application to be held pending the approval of any other type of assistance.
EXAMPLE
Ms. Quimby applies for MA and QMB coverage on July 5, 1991. She is a resident of a nursing facility, therefore, the worker must receive DA-124 information for level of care certification prior to MA approval. On July 30, the worker receives all necessary verification except the DA-124 information. Although the MA application cannot be completed, the worker must make a decision on the QMB application.
Eligibility for coverage under QMB can begin no earlier than the first of the month following the month the eligibility determination is made. There are no provisions for QMB coverage for the month of application through the month of decision, or for prior quarter coverage, therefore, timely application processing is important.
QMB applications are taken on an individual basis. Although the income and resources of a spouse who lives in the home are considered, if the spouse of the claimant wants to be considered for QMB coverage, take a separate application. If the applicant is interested in QMB and another program, take applications for both types of assistance. If an applicant for another program who is Part A eligible does not specifically decline QMB assistance, take applications for both programs.
All regular IM application procedures apply. The use of the IM-1 and IM-2 or IM-1MA, TPL information and availability of fair hearings is the same as for any other adult Medicaid program. Instruct the client to complete pages 1-7 of the IM-2.
QMB coverage can be requested alone or in combination with other types of assistance. Following are approval situations, which occur with the QMB program. These procedures were developed to ensure accurate statistics on worker production and QMB eligibles. Carefully follow these procedures as appropriate for QMB-only and QMB/combination applications.
Take the following steps to approve a case as QMB only:
NOTE: The month of determination is the month eligibility is established, regardless of when the IMU5 transaction is entered.
Take the following steps to approve QMB in combination with another type of assistance:
NOTE: THE QMB ELIGIBILITY DATE CANNOT PRECEDE THE FIRST OF THE MONTH FOLLOWING THE MONTH OF THE DETERMINATION.
Some individuals will not be Part A Medicare eligible when they apply for Medicaid and therefore, not QMB eligible. If an individual receiving some other type of assistance subsequently becomes Part A eligible and requests QMB coverage, take the following actions:
Routinely explore eligibility for QMB when reinvestigating recipients of other types of assistance. If the claimant does not already receive QMB coverage and appears to be eligible, discuss the benefits of QMB and take appropriate action. Use the above procedure (for approval only) in these situations.