State of Wisconsin Department of Health Services

Release 26-01 February 13, 2026

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32.10 Medicare Savings Programs Renewals and Changes

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. certification periods are 12 months. The first required renewal is 12 months from the most recent certification month.

32.10.1 QMB Renewals

QMB benefits begin on the first of the month following the renewal due month, if the renewal is confirmed during the renewal month or the month following the renewal month.

While a timely QMB renewal is being processed, the benefit is maintained until the redetermination is completed. (See MEH 3.1.1 Timely Renewals). When a timely renewal is pended, and verification to complete the renewal is also received timely and the member remains eligible for QMB, the new certification period should align with the extended month(s) of eligibility and there should be no gap in coverage. 

Example 1

Diamond’s Medicaid and QMB are due for renewal in February. She submits a renewal on February 20. Because a timely renewal is initiated, Medicaid and QMB coverage are maintained through March while the renewal is being processed. Verification of assets is requested and received on March 3 to complete her QMB renewal. Her new certification period begins April 1. There is no gap in her QMB eligibility.

If timely verification is received and the member is no longer eligible, or if verification is not received, MSP eligibility ends based on the following:

• Eligibility redetermined before adverse action, closure is effective the first of the following month.
• Eligibility redetermined after adverse action, closure is effective the first of the month after the following month.

Example 2

Susan’s Medicaid and QMB are due for renewal in February. She submits a renewal on February 3. Verification of assets is requested with a due date of February 23. Because her renewal is received timely, health care benefits are maintained for March. Verification is received and processed on February 23, and she is no longer eligible for QMB. QMB coverage ends effective April 1.

For late QMB renewals that have all needed verification processed in the month following the renewal due month, there should be no gap in coverage.

Example 3

Meghan’s Medicaid and QMB are due for renewal in February. She submits a late renewal on March 3. Because her renewal is received late, health care benefits are not maintained. Verification of assets is requested with a due date of March 23. Verification is received on March 19. Her new certification period for Medicaid and QMB begins March 1. There is no gap in her QMB eligibility because the renewal was confirmed in the month following the renewal due month.

For late renewals with needed verification processed in the second or third month following the renewal due month, there will be a gap in QMB coverage.

Example 4

Eve’s Medicaid and QMB are due for renewal in February. She submits a renewal on April 3, requesting a one month backdate. Because her renewal is received late, health care benefits are not maintained. Verification of assets is requested with a due date of April 23. Verification of assets for March and April are received on April 19. Her new certification period for Medicaid begins April 1 with a backdate to March 1 and QMB begins May 1. There is a gap in her QMB eligibility because the renewal was not confirmed in the renewal due month or the month following the renewal due month.

32.10.2 QMB Changes in Circumstance

While a change in circumstance is being processed, QMB benefits are maintained until the redetermination is completed. 

If timely verification is received and all other eligibility requirements are met, there should be no gap in coverage, even if the member changes MSP categories.

If timely verification is received and the member is no longer eligible, or if verification is not received, MSP eligibility ends based on the following:

• Eligibility redetermined before adverse action, closure is effective the first of the following month.
• Eligibility redetermined after adverse action, closure is effective the first of the month after the following month.

32.10.3 SLMB, SLMB+, QDWI Renewals

While a timely SLMB, SLMB+, or QDWI renewal is being processed, the benefit is maintained until the redetermination is completed. See MEH 3.1.1 Timely Renewals. 

If timely verification is received and all other eligibility requirements are met, there should be no gap in coverage, even if the member changes MSP categories.

Example 5

Donald’s MAPP and SLMB are due for renewal in February. He submits a renewal on February 20. Because a timely renewal is initiated, MAPP and SLMB coverage are maintained through March while the renewal is being processed. Verification of assets is requested and received on March 3 to complete his MAPP and SLMB renewal. His new certification period begins April 1. There is no gap in his SLMB eligibility.

If timely verification is received and the member is no longer eligible, or if verification is not received, MSP eligibility ends based on the following:

• Eligibility redetermined before adverse action: closure is effective the first of the following month.
• Eligibility redetermined after adverse action: closure is effective the first of the month after the following month.

Example 6

Jay’s MAPP and SLMB are due for renewal in February. He submits a renewal on February 3. Because his renewal is received timely, health care benefits are maintained for March. Verification of assets is requested with a due date of February 23. Benefits are maintained for March. Verification is received and processed on February 23, and he is no longer eligible for SLMB. The effective date of the SLMB termination is April 1.

32.10.4 SLMB, SLMB+, QDWI Changes in Circumstance

While a change is circumstance is being processed, SLMB, SLMB+, or QDWI benefits are maintained until the redetermination is completed.

If timely verification is received and all other eligibility requirements are met, there should be no gap in MSP coverage, even if the member changes MSP categories.

If timely verification is received and the member is no longer eligible, or if verification is not received, MSP eligibility ends based on the following:

• Eligibility redetermined before adverse action, closure is effective the first of the following month.
• Eligibility redetermined after adverse action, closure is effective the first of the month after the following month.

32.10.5 Program Choice 

While a renewal or a change in circumstance is being processed, the benefits that were open during the month of the change are maintained into the following month until the redetermination is completed. If a member receives full-benefit Medicaid that is maintained while a renewal or change is being processed, but is determined no longer eligible for full-benefit Medicaid (but is eligible for SLMB+), SLMB+ eligibility must be determined for the months when full-benefit coverage was maintained. See MEH Section 3.1.5 Program Changes at Renewal and MEH Section 3.3.3 Program Changes.

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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