(Revised 12/1/19 ML #3569)
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IM 5382
(N.D.A.C. Sections 75-02-02.1-22(1) and 75-02-02.1-10)
Individuals who are in receipt of SSI income and have Medicare will be determined eligible under the SSI Buy-In program. Individuals covered under SSI Buy-In are not eligible for coverage under the Medicare Savings Programs for the same time period. The SSI Buy-In program is the primary coverage for individuals who could qualify under both programs.
There are two exceptions:
- For individuals whose fluctuating income causes them to ‘bounce’ off and on SSI, the preferred coverage is under the Medicare Savings Program during the period of fluctuating income.
- Individuals that want Medicare Part A coverage, but do not have free Medicare Part A coverage, and are requesting that ND pay the Medicare Part A premium. If the individual comes from another state and the other state has been or is paying the Medicare Part A premium and they are eligible for QMB coverage ND would continue to cover the Medicare Part A.
Individuals not eligible for SSI buyin, coverage will be determined under the Medicare Savings Program. The individual must have Medicare Part A to be eligible under the following coverage types.
- Qualified Medicare Beneficiaries (QMB) 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).
- Specified Low-Income Medicare Beneficiaries (SLMB) 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 or the date the Social Security Administration received the Low Income Subsidy application.
- Qualifying Individuals (QI) 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 or the date the Social Security Administration received the Low Income Subsidy application. A review 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 credit form, SFN 828. A copy of the form can be found at 05-100-55.
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.
- Qualified Disabled Working Individuals (QDWI) are entitled to payment of their Medicare Part A premium only. To be eligible the individual needs to be under 65 years old, working, has lost their premium-free Medicare Part A due to returning to work, are receiving medical assistance and meet the income and resource limits. (The eligibility determination for this group will temporarily be done by the Medicaid Eligibility Division of the North Dakota Department of Human Services.) Coverage for this group began July 1, 1990.
