State of Wisconsin Department of Health Services

Release 24-01 April 03, 2024

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32.8 Medicare Beneficiaries Backdating

32.8.1 QMB Backdating

Occasionally, the benefits of a person who is eligible for QMBQualified Medicare Beneficiary do not correctly begin on the first of the following month. This can occur if:

• The eligibility process was not completed within 30 days.
• Certification of eligibility was not completed.
• A fair hearing decision has ordered backdated QMB benefits.

See Process Help Section 61.2.2 for instructions for QMB backdating.

32.8.2 SLMB, SLMB+, QDWI Backdating

Benefits can be backdated for up to three months prior to the month of application. Use the backdating guidelines in Section 2.8.2 Backdated Eligibility.

A person cannot receive backdated SLMBSpecified Low-Income Medicare Beneficiary, SLMB+Specified Low-Income Medicare Beneficiary Plus, or QDWIQualified Disabled and Working Individual benefits for months in which he or she would have been eligible for QMB.

Example:

Henry applied for MSPMedicare Savings Programs. Assistance to help pay coinsurance, premiums, and deductibles for Medicare beneficiaries who are also one of these types of Medicaid recipients: QMB, SLMB, SLMB+, or QDWI. This has also been called "Medicare buyin," "buy in," or "Medicare Premium Assistance (MPA)." DHS is using the term "MSP" to refer to this type of assistance. on June 15. He also requested a three-month backdate. His income for June was under the QMB income limit (100% of the FPL). He was determined eligible for QMB for ongoing months. His backdated eligibility was denied because his income in each of the backdated months of March, April, and May was under the QMB income limit (100% of the FPL). Since he would have been QMB eligible in the backdate period, he cannot receive backdated SLMB or SLMB+ benefits.

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The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030