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VA Medicare Related Covered Groups

Individuals who are eligible for Medicare and who meet one of the following covered groups may receive limited Medicaid coverage. Medicaid pays a portion of the Medicare premium on behalf of these Medicare beneficiaries.

These groups are also known as Medicare Savings Programs (MSP).

NOTE: Beginning January 1, 2010 the resource limit for QMBs, SLMBs and QIs is the limit that is used by the Medicare Part D Low Income Subsidy program, referred to as the Extra Help program. See section M2040.200B of the Department of Social Services (DSS) Medicaid Manual for the most recent information.

·             Qualified Medicare Beneficiaries (QMB) must be eligible for Medicare Part A. Their countable income must be at or below 100% of the Federal Poverty Level (FPL) and (effective 1/1/2010) their total resources must be not more than $6,600 for a single person and $9,910 for a couple.

Medicaid pays the Medicare Part A and Part B premiums, coinsurance, and deductibles.

·             Special Low-Income Medicare Beneficiaries (SLMB) must be eligible for Medicare Part A. Their countable income must be between 100% and 120% of the Federal Poverty Level (FPL) and (effective 1/1/2010) their total resources must be not more than $6,600 for a single person and $9,910 for a couple.

Medicaid pays the Medicare Part B premiums.

·             Qualified Disabled and Working Individuals (QDWI) must be eligible for Medicare Part A. Their countable income must be at or below 200% of the Federal Poverty Level (FPL) and their total resources must be at or below $4,000 for a single person and $6,000 for a couple (twice the maximum amount of resources that an individual or couple may have and be eligible for SSI). They must be employed and have been previously eligible for SSDI but lost their entitlement because of earning over the Substantial Gainful Activity (SGA) level.

Medicaid pays the Medicare Part A premium.

·             Qualified Individuals (QI) must be eligible for Medicare Part A. Their countable income equals or exceeds 120% but is less than 135% of the Federal Poverty Level (FPL). Their resources (effective 1/1/2010) must be not more than $6,600 for a single person and $9,910 for a couple.

Medicaid pays the Medicare Part B premium.

NOTE: When implemented on January 1, 1998, the QI covered group consisted of two components, Group 1 and Group 2. Group 1 individuals received Medicaid coverage for the payment of their Medicaid Part B premium. Group 2 individuals received Medicaid coverage for the portion of the Medicare Part B premium that is attributable to the cost of transferring coverage of home health services to Medicare Part B from Part A. The federal authority for Group 2 expired and Medicaid coverage for this component ended December 31, 2002. Effective January 1, 2003, the QI covered group consists only of the component formerly referred to as "Group 1".

NOTE: For special rules regarding inheritances and real estate resources for QMBs, SLMBs, and QIs see Appendix 2 of Chapter S11 of the Department of Social Services (DSS) Medicaid Manual. For special resource rules regarding QDWIs see Appendix 1.

See Also:

VA Medicaid Income Limits

VA Medicaid Resource Limits

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source:

Information for this topic was drawn from Sections M0310.125-129, M1110.003, and M2040.200B of the Department of Social Services (DSS) Medicaid Manual.

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