- What is the Qualified Individual (S06) medical program?
- Who is eligible to receive Qualified Individual (S06) medical?
- How long is the Qualified Individual (S06) certification period?
Online Processing
- How do I screen Qualified Individual (S06) medical?
- How do I process a pending Qualified Individual (S06) Assistance Unit (AU)?
- What if the client is active on Qualified Individual (S06) medical and applies for Categorically Needy (CN) or Medically Needy (MN) medical?
- How do I close the Qualified Individual (S06) medical when opening Categorically Needy (CN) or Medically Needy (MN) medical?
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 182-517-0100 Federal medicare savings programs.
Who is eligible to receive Qualified Individual (S06) medical?
A person meeting the following conditions is eligible to receive S06 medical:
- Is eligible for or receiving Medicare.
- Has countable income greater than 120% but not more than 135% of the Federal Poverty Level (FPL) and countable resources at or below the resource standards. For more information, see Apple Health eligibility manual - WAC 182-517-0100 Federal medicare savings programs -- Monthly income standards.
- Is not receiving Categorically Needy (CN) or Medically Needy (MN) medical coverage under any other program.
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:
- 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.
- 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 [Medicare Enrollment Date].
- Policy Number field - Enter [Social Security claim number] or
- MBI field - Enter [Medicare Beneficiary Identifier number], if applicable.
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?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.