9006 - QMB Eligible - Buy-In Rejected - No Part A Entitlement - Urgent

This alert is generated to advise the EW that the state has initiated an accretion transaction for Part B Buy-In for the recipient but the transaction was rejected. According to SSA in Baltimore, this recipient is not entitled to Medicare Part A.

Since ‘non-entitlement’ to Medicare Part A renders a recipient INELIGIBLE for QMB, the EW must take action to discontinue QMB eligibility.

The alert has triggered an automatic action in CalSAWS to update the Collect Medicare Expense Detail window and discontinue the client’s QMB eligibility.

Action Required

Verify whether the recipient has confirmation of Part A entitlement via INQB screen on MEDS or IEVS report. If necessary, refer the recipient to the local SSA office to obtain the verification.
If the recipient is NOT entitled to Part A, review the Medicare Detail and EDBC Results pages to ensure QMB eligibility is properly discontinued by the automatic action.
- If YES, no further action is required.
- If NO, discontinue QMB by updating Medicare Detail page. CalSAWS will generate an EW40 (Terminate) batch transaction to terminate the recipient’s QMB eligibility on MEDS.
If the recipient believes that he/she should be entitled to Part A Medicare, refer the recipient to the local SSA office to resolve the problem. In the interim, the recipient’s QMB eligibility must be terminated on both MEDS and CalSAWS.
If the recipient has current proof of Medicare Part A entitlement or MEDS displays Medicare Part A benefit, complete the State Medicare Buy-In problem form.

Refer to MC HB Chapter 5: Medicare Coverage, Section State Medicare Buy-In Problem Form for additional details on Medicare Buy In unit.

9006 - QMB Eligible - Buy-In Rejected - No Part A Entitlement - Urgent

Action Required

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