Medicaid Application Forms

Medically Needy – Provides Medicaid for persons with high medical bills but who are not eligible for Medicaid because their income or assets are too high. Those enrolled in this program must incur a certain amount of medical bills each month, which is known as “share of cost”. This amount is based on income and household size. Once the share of cost is reached, the DCF can approve full Medicaid benefits for the remainder of that month only. Medicaid does not cover the costs of prescription drugs for Medicare recipients who must now use the Medicare Part D prescription coverage. Medically Needy Program Brochure

Medicare-Medicaid Buy-In Programs

Qualified Medicare Beneficiary (QMB) – Individuals who qualify for QMB are eligible to have Medicaid pay for Medicare Premiums for Parts A and B, Medicare deductibles, and Medicare coinsurance within the prescribed limits. This is the only Medicaid benefit. Eligibility requirement as of 2015: Individual gross monthly income of $1,001. Couple gross monthly income of $1,348.

Special Low Income Medicare Beneficiary (SLMB) – Individuals who are eligible for SLMB are eligible to have Medicaid pay Medicare directly for Medicare premiums for Part B. This is the only Medicaid benefit. Eligibility requirement as of 2015: Individual gross monthly income of $1,197. Couple gross monthly income of $1,613.

Qualified Individuals (QI-1) – Individuals who are eligible for QI1are eligible to have Medicaid pay Medicare directly for Medicare premiums for Part B. The income limits are higher than SLMB and payment is only guaranteed through the end of the year the application was made. This is the only Medicaid benefit. Eligibility requirement as of 2015: Individual gross monthly income of $1,345. Couple gross monthly income of $1,813.

Medicaid-Medicare Buy In Application