The QMB and SLMB programs are not new, but are little known and, some feel, underutilized. MassHealth administers these programs for Medicare beneficiaries with limited incomes and assets. The Qualified Medicare Beneficiary (QMB) program, pays Medicare Part A premiums (if not free), and Part B premiums, co-payments and deductibles. Income must be at or below 100% of the Federal Poverty Level (FPL) and assets cannot exceed $4,000 for one person and $6,000 for a couple. The income standard is $671/month for an individual and $905 for a couple.

The Specified Low-income Medicare Beneficiary program, SLMB, pays only for the Medicare Part B premium, which for 1999 is $45.50/month. To qualify the person must have income at 120% FPL or less, or $805/month individual, $1085/month couple. The asset limit is the same as above.

The Qualified Individual (QI or QI 1) program is a new program that starts 4/1/99 and is for those not eligible for MassHealth. The benefits are the same as SLMB, but the income standard is 120% - 135% FPL. Asset limits are the same as above. There is also a QI 2 program for those with income between 135% and 175% FPL. QI 2 has a small benefit-$1.07/month for Medicare premiums.

Those over 65 who live in the community (i.e., not in a nursing home) have special eligibility criteria, different than the under 65 population who are covered under rules established by the 1996 Health Care Reform (HCR). Eligibility criteria for the over 65 population is the same as it was prior to the 1996. Assets are counted, whereas only income is counted for the HCR cases. There is a 36-month "look-back" period for transfers of assets. Deductibles and spend-downs still apply to this group. To the benefit of this population, the 90-day retroactive assistance applies. HCR cases only have a 10-day retroactive period.

If one receives both SSI and SSDI and get an SSDI cost-of-living adjustment that would make him/her ineligible for SSI she/he can apply to have the SSI benefit frozen. Just speak to the caseworker involved and ask about the process to obtain Pickle Amendment Protection.

MassHealth Limited is available to undocumented people, but only covers emergency care. The literature states that organ transplants are not covered, but in practice this decision is made on a case-by-case basic.

Persons enrolled in MassHealth Basic, Standard and Family Assistance are required to enroll in a managed care plan. MassHealth Basic members have 15 days from receipt of informational literature to sign up. There is no MassHealth coverage for this group until they do so. MassHealth Standard and Family Assistance members have 30 days to sign up and have fee-for-service coverage during that time period. Currently members can change from one offered plan to another at any time and as many times as they desire. It takes from one to a couple of days to make these changes. Please note that Tufts Health Plan and HMO Blue do not participate.

Basic members must use the Partnership (800-998-6462) to obtain service. There is no set limit on the number of visits any managed care plan member may receive. In other words, though many HMOs set a maximum of 12 mental health visits per year for their members, MassHealth members who are enrolled in the same HMO are not subject to these limits. If the HMO is telling the MassHealth member otherwise, the client should call the MassHealth customer service number: 800 841-2900