California Department of Social Services - State Hearings Division
Notes from the Training Bureau - December 2, 1998

Reference: ACWDLs 97-45 and 98-15

The Balanced Budget Act of 1997 established a new Medi-Cal program which pays some or all of the Medicare Part B premium for those eligible to the QI program. The QI program is divided into the QI-1 and QI-2 programs. This ACWDL describes some interim procedures for counties in implementing the QI program.

If an individual has income under 100% of the Federal Poverty Level (FPL) and meets other eligibility criteria such as residency and resource limits, the individual is eligible under the QMB program.

If an otherwise eligible individual has income between 100% and 120% of the FPL, the individual is eligible for the SLMB program.

If an otherwise eligible individual has income at least 120% but less than 135% of the FPL, the individual is eligible under the QI-1 program. The QI-1 program will pay the full Part B Medicare premium.

If an otherwise eligible individual has income in excess of 135% but less than 175% of the FPL, the individual is eligible under the QI-2 program. The QI-2 program reimburses once a year a portion of all monthly Part B premiums which an individual paid during months in the prior year.

The resource limit for the QMB, SLMB and the QI programs is $4000 for an individual and $6000 for a couple.

This ACWDL also has an FPL chart as an attachment. That chart includes Medi-Cal maintenance needs for family sizes 1 to 10 as well as 100%, 120%, 135% and 175% of FPL levels for family sizes 1 to 10.