Thursday, March 21, 2013

Many Seniors Receive QMB/SLMB/QI Terminations in Error

Some low-income seniors in West Virginia have recently gotten erroneous notices that they are no longer eligible for their QMB, SLMB, or QI benefits because their incomes went over the limit when they got their Social Security Cost of Living Adjustment (COLA) in January 2013. If the only change in their income/assets was the COLA then that notice is an error. Federal law prohibits DHHR from considering the amount of the COLA for benefits eligibility until March or April of each year (the second month after the new federal poverty guidelines are issued and the eligibility limits increase accordingly). These clients are not likely to know that the termination is a mistake. They can take steps to correct and get back on the benefits and get refunds for any premiums incorrectly deducted from their benefits, but many may need help to do that.

Dual eligibles are Medicare beneficiaries who also receive some Medicaid benefits because of their limited income and assets. There are three programs for dual-eligibles: Qualified Medicare Beneficiary (QMB), Specified Low-Income Beneficiary (SLMB) and Qualifying Individuals (QI), each providing different packages of Medicaid benefits to the Medicare beneficiary. All three of the programs include the benefit of Medicaid paying the beneficiary's Medicare Part B premium, which for most people is currently $104.90 per month.

The dual eligibles who are most likely to have received the erroneous notice are those whose incomes were close to the eligibility limits. If you work with low-income seniors in any capacity you may be able to help identify people who need assistance to get those benefits back, and help them get successfully referred for that help.

West Virginia Senior Legal Aid (WVSLA) and Legal Aid of West Virginia (LAWV) are working together to try to resolve this problem for anyone who was wrongfully terminated. Senior services programs, homecare providers, healthcare providers, and others who work with seniors can help by checking with their clients who receive QMB/SLMB/QI and asking if they have gotten a letter from DHHR terminating their benefits. If yes, they may be able to get assistance from the Aging and Disability Resource Centers at 1-866-987-2372 or Medicare Counselors with the State Health Insurance Assistance Program (SHIP) program at 1-877-987-4463. WVSLA and LAWV will coordinate with both ADRC and SHIP to help assure affected clients have their rights and benefits protected. There will be at least two important issues that need to be resolved for these clients: 1) getting the QMB/SLMB/QI benefit restored, and 2) getting refunds from Social Security for any premiums deducted from their benefits that should not have been.

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