WAC 182-517-0320

Effective July 1, 2012

WAC 182-517-0320 Medicare savings and state-funded Medicare buy-in programs cover some client costs.

  1. For qualified Medicare beneficiary (QMB) clients, the agency pays medicare Part A premiums (if any) and medicare Part B premiums the first of the month following the month the QMB eligibility is determined. The agency pays, in accordance with WAC 182-502-0110, medicare coinsurance, deductibles, and copayments for medicare Part A, Part B and medicare advantage Part C.   
  2. For specified low-income Medicare beneficiary (SLMB) clients, the agency pays Medicare Part B premiums effective up to three months prior to the certification period if eligible for those months. No other payments are made for SLMBs.  For clients eligible for both SLMB and medicaid, the agency pays medicare Part B premiums and other medical costs in accordance with WAC 182-502-0110.
  3. For qualified individual (QI-1) clients, the agency pays Medicare Part B premiums effective up to three months prior to the certification period if eligible for those months unless:
    1. The client receives Medicaid categorically need (CN) or medically needy (MN) benefits; and/or
    2. The agency’s annual federal funding allotment is spent. The agency resumes QI-1 benefit payments the beginning of the next calendar year.
  4. For qualified disabled working individual (QDWI) clients, the agency pays Medicare Part A premiums effective up to three months prior to the certification period if eligible for those months. The agency stops paying Medicare Part A premiums if the client begins to receive CN or MN Medicaid.
  5. For state-funded Medicare buy-in program clients, the agency pays, in accordance with WAC 182-502-0110, medicare Part B premiums.  Cost sharing for medicare deductibles, copayments and coinsurance is paid by the categorically needy (CN) or medically needy (MN) medicaid program.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.