QMB Approval

Case Situation

Disabled individual applies for QMB only. Social Security disability income and Medicare part A and B was reported. The EW clears Non-MAGI MC eligibility and approves QMB aid code (80).

Refer to CalSAWS "Job Aid (JA) QMB Approval", for additional QMB processing instructions.

1. On the Case Summary page click on View Details in Medi-Cal Program page section.
2. Click Edit on the Medi-Cal Detail page, when page refreshes click Edit in the Program Person page section.
3. On the Medi-Cal Person Detail page click Add in the Request Medi-Cal Type page section.
4. On the Requested Medi-Cal Type Detail page:

• Select Medicare Premium Payment Program from the drop down list. 
•  Complete other mandatory fields.

       5. Click on Save and Return all the way out.

       6. On the Income List page select Social Security from the Income Category drop down list and update necessary information on the Income Detail page:

       7. On the Medicare Detail page:

• Enter Medicare part A&B information, MBI number and HIC number.
• Complete all necessary fields.

8. Complete other Data Collection pages relevant to the case. 

9. Run EDBC, review budget and eligibility results on the Medi-Cal EDBC Summary page and Accept and Save results.

• The Eligible Budget for MEDS page section signifies the Aid Codes that will be sent to MEDS. 

Click hereClick here for CalSAWS step-by-step process.

Transactions Generated by CalSAWS to MEDS

An open period Add (EW20) transaction will be sent to MEDS. QMB eligibility is recorded on the INQ1 screen with an ELIG-STAT code of 891 until accretion has taken place. The ELIG-STAT will be changed to 301 after the record is successfully added into the QMB Buy-In program.

Refer to MC HB Chapter 20: Medicare Coverage, for detailed information on the QMB program.

Related Topics

Pickle Approval

Retroactive Medi-Cal Approval

TB Program Approval

Terminations

Deceased Individual - Termination

SSI Recipient - Termination