Qualified Individual (QI-1) (S06)

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is the Qualified Individual (S06) medical program?

S06 medical is a Medicare Savings Program that pays client’s Medicare Part B premiums. For more information about this program, see Apple Health eligibility manual - WAC 182-517-0300 Federal Medicare savings and state-funded Medicare buy-in programs.

Who is eligible to receive Qualified Individual (S06) medical?

A person meeting the following conditions is eligible to receive S06 medical:

How long is the Qualified Individual (S06) certification period?

The S06 medical program is certified from the month the Assistance Unit is opened through the end of the current calendar year. For more information, see Apple Health eligibility manual – WAC 182-504-0025 Medicare savings program certification periods.

Online Processing

How do I screen Qualified Individual (S06) medical?

An S06 Assistance Unit (AU) is initially screened in as a Qualified Medicare Beneficiary (S03) AU following the instructions in How do I screen Qualified Medicare Beneficiary (S03) medical?

How do I process a pending Qualified Individual (S06) Assistance Unit (AU)?

To process a pending S06 AU complete the following:

  1. Follow the Qualified Medicare Beneficiary (S03) processing steps in How do I process a pending Qualified Medicare Beneficiary (S03) Assistance Unit (AU)?
  • If eligible, the S03 AU trickles to S06 medical when finalized. 
  1. On the Third Party Liability page, in addition to entering Medicare Part A eligibility, enter the Medicare Part B eligibility as follows:
  • Organization Code field - Enter [MEDB].
  • Policy Effective Dates field - Enter the [Medicare Enrollment Date].
  • Policy Number field - Enter the [policy number on the Medicare Card].

What if the client is active on Qualified Individual (S06) medical and applies for Categorically Needy (CN) or Medically Needy (MN) medical?

A client cannot receive S06 when receiving CN or MN medical under any other program. You must close the S06 Assistance Unit (AU) for all months that the client is requesting CN or MN medical.

A client can be active on an S06 AU while on a Medically Needy SSI Related Medical With Spenddown (S99) AU in MA Spenddown (M) status. The S06 AU must be closed in all months for which S99 AU is opened before authorizing the S99 to go from MA Spenddown (M) to Active (A) status.

How do I close the Qualified Individual (S06) medical when opening Categorically Needy (CN) or Medically Needy (MN) medical?

You must manually close the S06 Assistance Unit (AU) with a 500-level reason code in all historical months where a CN or MN medical program is opened for the client. For additional information on 500-level codes, see What Reason Codes can be entered on the Assistance Unit (AU) Details page?

Mainframe Processing

How do I screen Qualified Individual (S06) medical?

An S06 Assistance Unit (AU) is initially screened in as an Qualified Medicare Beneficiary (S03) AU following the instructions in How do I screen Qualified Medicare Beneficiary (S03) medical?

How do I process a pending Qualified Individual (S06) Assistance Unit (AU)?

To process a pending S06 AU complete the following:

  1. Follow the Qualified Medicare Beneficiary (S03) processing steps in How do I process a pending Qualified Medicare Beneficiary (S03) Assistance Unit (AU)?
  • If eligible, the S03 AU trickles to S06 medical when finalized.
  1. On the TPL1 screen, in addition to entering Medicare Part A eligibility, enter the Medicare Part B eligibility as follows:
  • Org field - Enter [MEDB].
  • Policy Effective Dates From field - Enter the [Medicare Enrollment Date].
  • Policy Number field - Enter the [policy number on the Medicare Card].

What if the client is active on Qualified Individual (S06) medical and applies for Categorically Needy (CN) or Medically Needy (MN) medical?

A client cannot receive S06 when receiving CN or MN medical under any other program. You must close the S06 Assistance Unit (AU) for all months that the client is requesting CN or MN medical.

A client can be active on an S06 AU while on a Medically Needy SSI Related Medical With Spenddown (S99) AU in [M] - MA Spenddown status. The S06 AU must be closed in all months for which S99 AU is opened before authorizing the S99 to go from [M] - MA Spenddown to [A] - Active status.

How do I close the Qualified Individual (S06) medical when opening Categorically Needy (CN) or Medically Needy (MN) medical?

You must manually close the S06 Assistance Unit (AU) with a 500-level reason code in all historical months where a CN or MN medical program is opened for the client. For additional information on 500-level codes, see What Reason Codes can be entered on the STAT screen?

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.