Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.10-001 - Medicare Savings Medicaid Program Policy 23010 and 23110

Current through Register Vol. 49, No. 6, June, 2024
23000
Medicare Savings Programs
Since 1988, several laws have been passed requiring states to
				provide savings to certain Medicare recipients through the state's Medicaid
				program. The categories enacted are Qualified Medicare Beneficiaries (QMB)
				including ARSeniors, Specified Low-Income Medicare Beneficiaries (SMB),
				Qualifying Individuals -1 (QI-1), Qualified Disabled and Working Individuals
				(QDWI). These categories provide Medicare savings by paying the Medicare
				premium(s) or a portion of the Medicare premium, and possibly the Medicare
				deductibles and coinsurance. Except for ARSeniors, these categories do not pay
				for the full range of Medicaid services.
*
			 23010
Medicare Savings Programs -
			 Comparison Chart
The comparison chart on the next page provides a brief overview
				of the six categories including the coverage provided and eligibility
				requirements.
ARSeniors
QMB
SMB
QI-1
QDWI
Benefits
Full Range of
Medicaid Benefits
Pays Medicare Premium(s), deductible and
						  coinsurance
Pays Part B Premium
Pays Part B Premium
Pays Part A Premium
Categorical
Aged Only
Aged, Blind or Disabled
Aged, Blind or Disabled
Aged, Blind or Disabled
Blind or Disabled
Income Limits
Equal to or below 80% of FPL
100% of the Federal Poverty Level (FPL)
Between 100% and 120% of FPL
At least 120% but less than 135% of FPL
200% of FPL
Resource Limit
* Individual $6600.00
* Couple $9910.00
Individual $4000
Couple $6000
Certified in other category at same time?
No
Yes
Yes
No
Yes
Medicare Requirements
Must receive Medicare if entitled to
						  Medicare
Entitled to or conditionally eligible for Medicare Part
						  A
Entitled to (actually receiving) Medicare Part A and
						  B
Lost Medicare Part A & SSA-DIB benefits due to
						  SGA
Entitled to reenroll in Medicare Part A
Policy Re:
MS 23100
MS 23100
MS 23100
MS 23100
MS 23500
23100
History of ARSeniors, QMB, SMB. QI-1
1.
ARSeniors
:
			 Initiated Act 1 of 2000 authorizes expanded services to lower income Aged QMB
			 (Category 18) recipients. Funding for this program is provided from the Tobacco
			 Settlement funds. This coverage group is called ARSeniors and provides the full
			 range of Medicaid services to individuals receiving Aged QMB whose income is
			 equal to or less than 80% of the Federal Poverty Level (FPL). The ARSeniors
			 program was implemented effective November 1, 2002.
2.
QMB
: Section 301
			 of Public Law 100-360, the Medicare Catastrophic Coverage Act of 1988, requires
			 Medicaid buy-in of Medicare premiums and coverage of deductibles and
			 coinsurance for Qualified Medicare Beneficiaries (QMBs) with income at or below
			 100% of the FPL and resources at or below twice the SSI limit.
3.
SMB
: On January
			 1, 1993, Section 4501 of the Omnibus Budget Reconciliation Act of 1990 (
			 Public
			 Law 101-508 ) mandated that State Medicaid
			 Agencies pay the Medicare Part B premium for Specified Low Income Medicare
			 Beneficiaries (SMBs) for individuals with income between 100% and 110% of the
			 Federal Poverty Level. These limits became effective in 1994. Beginning in
			 1995, the SMB income limit increased to between 100% and 120% of the Federal
			 Poverty Level.
4.
QI-1
: Section 4732 of the Balanced Budget Act of 1997
			 (
			 Public
			 Law 105-33 ) created the Qualifying lndividuals-1
			 group (QI-1). Ql-1s are individuals who would be eligible for SMB except that
			 their incomes exceed the SMB level. Ql-1s must have income of at least 120% but
			 less than 135% of the Federal Poverty Level.
5.
QI-2
: Section
			 4732 of the Balanced Budget Act of 1997 (
			 Public
			 Law 105-33 ) also created the Qualifying
			 lndividuals-2 group (QI-2) with a sunset date of December 31, 2002. Ql-2s must
			 have income of at least 135% but less than 175% of the Federal Poverty Level.
			 The QI-2 program ended December 31, 2002, as it was not reauthorized by
			 Congress.