Medicaid Eligibility

Conducting a Medicaid eligibility check is a crucial step for understanding your client’s Medicaid level, particularly for clients who may qualify for Dual Special Needs Plans (DSNPs). Identifying Medicaid levels like QMB, SLMB, QI, and FBDE is vital for offering tailored plan recommendations.

Medicaid Levels:

1. Qualified Individual (QI): Covers Medicare Part B premiums.
2. Qualified Medicare Beneficiary (QMB): Covers Medicare Part A and B premiums, deductibles, coinsurance, and copayments.
3. Qualified Medicare Beneficiary Plus (QMB+): Offers the same benefits as QMB, with full Medicaid coverage for additional services.
4. Specified Low-Income Medicare Beneficiary (SLMB): Pays for Medicare Part B premiums.
5. Specified Low-Income Medicare Beneficiary Plus (SLMB+): Similar to SLMB, with added Medicaid benefits for certain services.
6. Full Benefit Dual Eligible (FBDE): Provides full Medicaid benefits alongside Medicare coverage.

Tools for Medicaid Eligibility Checks

Several carriers provide tools to simplify Medicaid eligibility verification:

These tools are designed to streamline the process and provide accurate eligibility information for your clients.

If the client doesnt have their medicaid ID with them or you suspect that they have medicad you can call the carriers to confirm.

Steps to Guide Clients If Applying for Medicaid or Extra Help:

Agents can assist clients in applying for both Extra Help and Medicaid using the following link: Extra Help Application.

If a client’s income is below their state’s Medicaid threshold:

Encourage clients to contact their local Medicaid office to apply for Medicaid benefits.

They will typically need:

• Three months of bank statements
• Other basic personal and financial information

Follow-Up With The Client

• Approval or denial letters usually arrive within 3-4 weeks.
• Stay engaged: Ask your client to inform you once they receive their Medicaid determination letter.
• Set reminders: Create a follow-up task in your CRM to check back on their Medicaid application status around the expected decision date.