References: ACWDL 98-60, 99-43

Medi-Cal Eligibility Procedures Manual §5L, H, 1 instructs counties to review medically needy applications and redeterminations for eligibility to the Qualified Medicare Beneficiary (QMB) program. If an individual is not eligible as a QMB due to income (i.e., has income in excess of 100% of the FPL) counties are to evaluate the individual for either the Specified Low Income Medicare Beneficiary (SLMB) program (income between 100% and 120% of the FPL) or the QI program (income between 120% and 135% of the FPL for QI-1 and between 135% and 175% of the FPL for QI-2)

If an individual is eligible for the QMB program, the DHS will pay Medicare Part A and Part B premiums, deductibles and coinsurance. If an individual is ineligible for QMB, but eligible for SLMB, the DHS will pay Medicare Part B,(i.e., outpatient) premiums. Persons eligible for QI-1 will have the Part B premium paid in full. Persons who are eligible under the QI-2 program will be reimbursed once a year for a portion of all monthly Part B premiums paid during months in the prior year.

Persons may be dually eligible for QMB and medically needy (MN) Medi-Cal, or SLMB and MN Medi-Cal if they meet Medi-Cal property limits. Although Federal law precludes a QI from being eligible for any other Medicaid program, an MN individual who receives Medi-Cal with a share of cost but who does not meet that share of cost in a given month, may be eligible as a QI in that month.