Medicare/Medicaid Crossover
Dual-eligible member tracking, D-SNP management, and cost-sharing liability
4,812
Dual-Eligible Members
↑ 3.2% vs prior month
3,144
D-SNP Enrollees
65.3% of duals on D-SNP
2,187
QMB Members
Zero cost-sharing required
143
MBI Mismatches
Needs reconciliation
QMB (Qualified Medicare Beneficiary) members must have no cost-sharing collected for Medicare-covered services. Providers who bill QMBs incorrectly are subject to disenrollment from Medicare.
| Member | Medicare Beneficiary ID (MBI) | Medicaid ID | Plan | MSP Category | Crossover Status | Cost-Sharing | |
|---|---|---|---|---|---|---|---|
Dorothy Pearce MBR-10041 |
3K75YT2AA00 | CA-2019-448811 | D-SNP Elite | QMB+ | Active | $0 Liability | |
Harold Metz MBR-10088 |
2T84KR5BB11 | CA-2021-339022 | D-SNP Elite | QMB Only | Active | $0 Liability | |
Miriam Okafor MBR-10112 |
MISMATCH | CA-2020-501234 | HMO Gold | SLMB | Pending | Partial | |
George Callahan MBR-10155 |
8J23NX9CC44 | CA-2018-112987 | D-SNP Elite | QI | Active | Premium Only | |
Lucinda Park MBR-10199 |
5H67PQ4DD55 | CA-2022-678345 | D-SNP Elite | QMB+ | Active | $0 Liability | |
Samuel Winters MBR-10234 |
1A90WE2EE66 | CA-2019-907654 | HMO Gold | SLMB+ | Active | $0 Liability | |
Evelyn Torres MBR-10278 |
4G12ZV7FF77 | EXPIRED | D-SNP Elite | Pending Review | Suspended | On Hold |
Showing 7 of 4,812 dual-eligible members
MSP Category Reference
QMB OnlyMedicare pays premium, deductible & coinsurance
QMB+QMB + full Medicaid
SLMBMedicaid pays Part B premium only
SLMB+SLMB + full Medicaid
QIQualified Individual — Part B premium only
QDWIQualified Disabled Working Individual
D-SNP Tracking
D-SNP Plan NameeKlotho D-SNP Elite (H1234-004)
CMS ContractH1234 — CA / AZ
MIPPA ComplianceCompliant
State MOC (MOU)Active — CA DHCS
HIDE SNP AlignmentPartial — 78% aligned
Next SEP WindowJan 1 – Mar 31, 2025