Department of Human Services
Self-Sufficiency Programs - Chapter 461
Division 135
SPECIFIC PROGRAM REQUIREMENTS
461-135-0730
Specific Requirements; QMB, SMB, SMF
(1) The following requirements apply to QMB-BAS:
(a) To qualify for QMB-BAS, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage.
(b) A client who qualifies for QMB-BAS is not eligible to receive the full range of the Department's medical services. QMB-BAS benefits are limited to payments toward Medicare cost-sharing expenses. These expenses are:
(A) Medicare Part A and Part B premiums; and
(B) Medicare Part A and Part B deductibles and coinsurance up to the Department's fee schedule.
(2) The following requirements apply to QMB DW:
(a) To qualify for the QMB-DW program, an individual must be eligible for Part A of Medicare as a qualified worker with a disability under Section 1818A of the Social Security Act (42 USC 1395i-2a). This is an individual under age 65 who has lost eligibility for Social Security disability benefits because the individual has become substantially gainfully employed, but can continue to receive Part A of Medicare by paying a premium.
(b) A QMB-DW client is eligible only for payment of premiums for Part A of Medicare. If the client is eligible for any other medical assistance program the client is not eligible for QMB-DW.
(3) The following requirements apply to QMB SMB:
(a) To qualify for QMB SMB, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage.
(b) A client who qualifies for QMB SMB is not eligible to receive the full range of the Department's medical services. QMB SMB benefits are limited to payment of Medicare Part B premiums.
(4) The following requirements apply to QMB-SMF:
(a) To qualify for QMB-SMF, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage.
(b) A client who is otherwise eligible for another Medicaid program offered by the Department or the Oregon Health Authority is not eligible for QMB-SMF.
(c) A client who qualifies for QMB-SMF is not eligible to receive the full range of the Department's medical services. QMB-SMF benefits are limited to payment for Medicare Part B premiums.
(d) The QMB-SMF program is subject to an enrollment cap based on the federal allocation. If the enrollment in this program exceeds the federal allocation, the program may be closed.
Statutory/Other Authority: ORS 411.060
Statutes/Other Implemented: ORS 411.060
History:
SSP 44-2016, f. 12-7-16, cert. ef. 1-1-17
SSP 5-2010, f. & cert. ef. 4-1-10
SSP 26-2008, f. 12-31-08, cert. ef. 1-1-09
Reverted to SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07
SSP 19-2008(Temp), f. & cert. ef. 8-8-08 thru 12-28-08
SSP 15-2008(Temp), f. & cert. ef. 7-1-08 thru 12-28-08
SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07
SSP 10-2006, f. 6-30-06, cert. ef. 7-1-06
SSP 3-2006(Temp), f. & cert. ef. 2-6-06 thru 6-30-06
SSP 17-2004, f. & cert. ef. 7-1-04
SSP 9-2004(Temp), f. & cert. ef. 4-1-04 thru 6-30-04
SSP 8-2004, f. & cert. ef. 4-1-04
SSP 33-2003, f. 12-31-03, cert. ef. 1-4-04
AFS 22-2002, f. 12-31-02, cert. ef. 1-1-03
AFS 19-2002(Temp), f. 12-10-02, cert. ef. 1-1-03 thru 5-31-03
AFS 15-1999, f. 11-30-99, cert. ef. 12-1-99
AFS 24-1997, f. 12-31-97, cert. ef. 1-1-98
AFS 35-1992, f. 12-31-92, cert. ef. 1-1-93
AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90
AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90