Medicaid – QMB, SLMB, QI & QDWI Program

1) These are the Medicare programs established to help low-income beneficiaries where Medicaid pays their Medicare Part A & Part B premium, Medicare coinsurance, and Medicare Deductible.

2) Below are the Medicare programs and their covered benefit,

• QMB (Qualified Medicare Beneficiary) Program: Medicaid will pay Medicare Part A premium, Medicare Part B premium, Medicare coinsurance, deductible & co-payment.
• SLMB (Specified Low-Income Medicare Beneficiary) Program: Medicaid will pay Medicare Part B premium.
• QI (Qualifying Individual) Program: Medicaid will pay Medicare Part B premium.
• QDWI (Qualified Disabled & Working Individual) Program: Medicaid will pay Medicare Part A premium.

3) You will find a scenario where a claim was paid by Medicare as primary and Medicaid denied the claim as secondary stating non-covered benefit, so you can check Medicaid eligibility to verify the patient enrolled program and covered benefit.

4) For example, When you check Medicaid eligibility & patient has an SLMB plan and the Medicare left balance is coinsurance then Medicaid will not cover it since SLMB covers Medicare Part B premium only then the claim needs to be released to the patient. 

(Note: In general guidelines, Medicaid patients should not be billed for any amount but check your client update and work accordingly. If Medicaid patient billing is allowed then you can release the claim to the patient. If it is not allowed then the balance needs to be written off.)