Individuals Covered and Benefits 510-05-60-10

(Revised 1/03 ML #2833)

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(N.D.A.C. Sections 75-02-02.1-22(1) and 75-02-02.1-10)

 

  1. Qualified Medicare Beneficiaries are entitled only to Medicare cost sharing benefits beginning in the month following the month in which the eligibility determination is made (i.e. the application is received on March 29, eligibility is determined in April, the first month of QMB eligibility is May).

  2. Specified Low-Income Medicare Beneficiaries are entitled only to payment of their Medicare Part B premium. Eligibility may be established for as many as three calendar months prior to the month in which the application was received.

  3. Qualifying Individuals are entitled only to payment to their Medicare Part B premium. Eligibility may be established for as many as three calendar months prior to the month in which the application was received. A redetermination of eligibility is required in December of each year to establish continued eligibility for the coming year.

Qualifying Individuals cannot be in receipt of any other Medicaid benefits for the same time period. A Qualifying Individual can request coverage for other Medicaid benefits, and eligibility can be established, only if the Qualifying Individual repays the Medicare cost sharing benefits received for the month(s) the other Medicaid benefits are needed. Medicaid benefits can only be authorized after the Medicare cost sharing benefits have been repaid.

 

When a recipient needs to repay Medicare cost sharing benefits, a check or money order can be made payable to the "North Dakota Department of Human Services" and collected by the county agency. The county agency must forward the check or money order to the Finance Division of the North Dakota Department of Human Services with a completed "Medicaid Refund Letter." A copy of the letter can be found at Appendix K.

 

Each year the federal government allocates a set amount of funds that can be used to provide coverage for Qualifying Individuals. In the event that the allocation for this state is exhausted in any given year, current recipients remain eligible, but additional persons cannot be added.