Qualifying Individual (QI-1) Program

The Qualifying Individual (QI-1) program pays Medicare Part B premiums. The QI-1 program is a federally funded program which is similar to the QMB and SLMB programs but has a higher income limit.

The following chart provides an overview of the QI-1 program:

Program	Aid Code	Benefit Provided	Income Limit	Program Requirements
Qualifying Individual-1 (QI-1)	8D	Buy-In of the Medicare Part B premium.	Income is equal to or more than the SLMB income limit (120% of FPL), but less than or equal to 135% of FPL.	Eligible for and receiving Medicare Part A. (Conditional Part A does not meet this criteria.) Is within the QI property limit. Not “eligible for MC”. Is a citizen or a Non-citizen who would otherwise be entitled to full-scope benefits. Meets the other MC eligibility requirements (e.g. residency, etc.)

Effective Date

Eligibility begins the month of application if all eligibility requirements are met.

Retroactive QI-1 Benefits

Individuals may apply for 3-month retroactive QI-1 benefits if they were entitled to Medicare Part A and B in those months and are otherwise eligible.

Benefit

Individuals who qualify for QI-1 program are eligible only for payment (Buy-in) of their Medicare Part B premium and no other benefit.

The QI-1 program pays the full Medicare Part B premium. Once Buy-In of the Part B premium begins, the premium will not be deducted from the recipient’s Social Security check. The customer’s net monthly income will increase.
The QI-1 program does not pay the Medicare Part A premium, nor for Part A and B deductibles and coinsurance.
If the client is eligible either for regular Medi-Cal, QMB or SLMB, there is no need to set up QI-1 because the buy-in is already taken care of.
QI-1 only recipients do not receive a MC BIC.

Eligibility Criteria

Individuals requesting QI-1 must meet all of the following eligibility criteria:

Medicare Part A

The individual must be eligible for Medicare Part A.

Important: “Conditional” Medicare Part A does not meet this requirement. QI-1 applicants must actually be eligible for and in receipt of Part A in order to be eligible for the QI-1 program.

Property

The property limit is:

$4,000 for one individual
$6,000 for two individuals

As of 1/1/2010 the property limit is three times the Supplemental Security Income property limit, plus an annual percentage increase equal to the increase in Consumer Price Index (CPI).

Resources must be declared on the statement of facts, but the customer is not required to provide verification. EWs must accept the client’s statement. Verification is only required when the client’s statement is inconsistent with information received from another source (i.e., IEVS).

Income

QI-1 eligibles must have income greater than the SLMB income limit (120% of the FPL), but less than or equal to the QI-1 income limit (135% of FPL).

Citizen/ Noncitizen Status

QI-1 eligibles must be a citizen or a Non-citizen who would otherwise be entitled to full-scope benefits if applying for regular MC. An undocumented Non-citizen who would only get restricted MC benefits is not eligible for QI-1.

When to Evaluate

QI-1 eligibility must be reevaluated whenever there is:

An annual redetermination due, or
A change in income, or
A change in the QI-1 income limits, or
A person becomes ineligible for QMB and SLMB.

Note: The QI-1 income limits change annually in April when the annual Federal Poverty Level (FPL) is established. The EW must disregard the Social Security Cost of Living Adjustment (COLA) between January 1 and March 31 of each year.

NOAs

Approval, denial and discontinuance NOAs are required for QI-1 applicants/recipients. Ten-day notice requirements apply.

Dual Eligibility

EWs must only establish QI-1-only eligibility. There is no dual eligibility for ABD-MN (zero or share of cost met) and the QI-1 program.

There is dual eligibility (regular MC and QI-1) for MC recipients who have not met their share of cost.