|
|
Medi-Cal Update 2024-5 Medicare Part A Automatic Enrollment into QMB
Medicare Part A Buy-In and Automatic Enrollment of Supplemental Security Income/State Supplemental Payment (SSI/SSP) Recipients into the Qualified Medicare Beneficiary (QMB) Program
| Date | References | Clerical | Implementation |
| 12/13/24 | ACWDL 24-01e, MEDIL I 24-17 | N/A | January 1, 2025 |
Background
The Qualified Medicare Beneficiary Program (QMB) requires the state to pay the Medicare premiums, deductibles, and coinsurance of low-income QMBs.
Changes
Through Senate Bill (SB) 311, signed on October 10, 2023, the Department of Health Care Services (DHCS) is required to enter into a Medicare Part A buy-in agreement for Qualified Medicare Beneficiaries (QMBs) through a state plan amendment which becomes effective January 1, 2025. This agreement allows DHCS to directly enroll QMB members in Medicare Part A and pay their Part A premiums.
DHCS will provide Part A buy-in for the following groups:
- SSI/SSP recipients,
- Qualified Medicare Beneficiaries (QMBs),
- Qualified Disabled and Working Individuals (QWDIs).
DHCS will submit Part A buy-in accretion for QMBs to establish Medicare entitlement at any time of the year, regardless of Medicare enrollment periods, and with no penalties or increased premiums due to late enrollment.
For an individual enrolled in QMB, Part A buy-in will begin the first month the eligibility for QMB is effective. If an individual becomes eligible for QMB in January 2025, the Part A buy-in will begin in January 2025.
The eligibility process for Medicare Savings Programs (MSPs) will not change for non-SSI Medicare-eligible individuals.
The Medicare Final Rule enacted by the Centers for Medicare and Medicaid Services (CMS) on September 21, 2023, also requires California to automatically enroll Supplemental Security Income (SSI) recipients into the QMB program.
Implementation
These changes will be implemented in a Two-Phased approach.
In Phase I, beginning October 1, 2024, DHCS will automatically enroll current SSI/SSP members who are eligible for premium-free Medicare Part A into the QMB program and who do not already have QMB active through the county. During Phase I, from October 1, 2024, through December 31, 2024, counties should follow existing policies and continue managing the existing SSI/QMB cases in CalSAWS. During Phase I, all newly eligible SSI/SSP members also eligible for premium-free Part A will be automatically enrolled into QMB by DHCS.
During Phase II, effective January 1, 2025, DHCS will automatically enroll all SSI/SSP eligible members into the QMB program, assign the QMB aid code (80) in MEDS, and send a Notice of Action (NOA) upon enrollment. Any current QMB case records in CalSAWS for SSI individuals will be automatically closed. These cases will be monitored by DHCS for ongoing maintenance of the records in MEDS. Effective January 1, 2025, counties shall no longer grant QMB eligibility for SSI individuals in CalSAWS. If an SSI individual applies for QMB with the county, the application should be denied as "aided on another case".
After January 1, 2025, counties shall continue to:
- Manage non-SSI QMB cases,
- Assist with mailing out replacement Benefit Identification Cards (BICs) for SSI members,
- Answer general questions related to Medi-Cal or MSPs,
- Refer SSI members to the Social Security Administration (SSA) for questions related to their SSI benefits,
- Refer SSI members to contact the Medi-Cal Helpline at 1-800-541-5555 for questions about the QMB program.
There is no change to the Craig v Bonta redetermination process when an individual's SSI benefits are discontinued.
Data Systems
SSI/SSP QMB individuals with a CalSAWS case will have their case closed during a CalSAWS system automation run scheduled for December 5, 2024, for the benefit month of January 2025.
Other Programs
These changes only affect the Medi-Cal Program.
Department of Employment & Benefits Services
Contact Person(s): Megan Turney, SSA BPIS