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Provider Notice issued 05/25/06
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Medicare Co-payments for Qualified Medicare Beneficiaries
On October 1, 2005, the department’s policy regarding payment for Medicare coinsurance days for Medicaid eligible persons changed. Medicare coinsurance paid by the department, if any, is now based on the amount that Medicare would actually pay for the specific resident’s care, not the coinsurance per diem amount in effect at the time. A nursing facility resident is still responsible for applying their income toward their cost of care unless they have been identified as being a Qualified Medicare Beneficiary (QMB). In this case, the resident is allowed to retain their income during the Medicare co-payment period.
Nursing facilities cannot require a QMB resident to apply any amount of their income toward their cost of care during the Medicare covered time period.
The Social Security Act at §1902(n)(3)(A) states that payment by Medicare, plus payment by the department, if any, is considered to be payment in full.
Payment from Medicare, or the department (if any), does not prevent payment of any Medicare cost-sharing by a Medicare supplemental policy or an employer retiree health plan on behalf of the resident.
Copies of this and previous notices may be found on the department’s Web site at: http://www.hfs.illinois.gov/ltc
If you have any questions, contact the Bureau of Long Term Care at 217-782-0545.
Anne Marie Murphy, Ph.D.
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