Qualified Medicare Beneficiary/Specified Low-Income Medicare Beneficiary, In re

(Ohio Dep’t of Human Servs. Apr. 28, 1995) ; Clearinghouse Number: 50756

Description

Ohio Agency Agrees to Improve Qualified Medical Beneficiary and Specified Low-Income Medicare Beneficiary Programs

Abstract

Pursuant to negotiations with advocates at the Legal Aid Society of Cincinnati, the Ohio Department of Human Services (DHS) has agreed to make changes intended to improve the Qualified Medicare Beneficiary (QMB) and Specified Low Income Medicare Beneficiary (SLMB) programs. Advocates had asserted that DHS (1) failed, in violation of 42 U.S.C. § 1396a(a)(10)(E)(i), to determine QMB eligibility for some individuals currently in receipt of benefits from DHS who were Medicare beneficiaries and whose income and resources fell below QMB standards; (2) failed to determine QMB eligibility for other individuals within the 45-day time limit prescribed by 42 U.S.C. § 1396a(a)(8); and (3) failed to reimburse individuals for Medicare cost-sharing expenses, including premiums, deductibles, and copayments, that individuals incurred solely due to DHS’s failure to determine QMB eligibility properly. DHS agreed to make changes in its computer eligibility determination programs so that QMB/SLMB eligibility is automatically determined whenever an applicant reports Medicare eligibility. DHS also agreed to implement a corrective payment policy so that individuals can receive payment directly from DHS to reimburse them for Medicare Part B premiums or other Medicare cost-sharing expenses that the individual paid due to erroneous QMB/SLMB eligibility determinations. Finally, DHS agreed to include language on all reapplication notices about the QMB and SLMB programs.

Additional Information

Attorney Information
For further information contact Hugh Daly, Legal Aid Society of Cincinnati, 901 Elm St., Cincinnati, OH 45202-1016, (513) 241-9400.
Docket Date
1995-04-28 00:00:00+00:00