State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
To be eligible for QMB the person must:
The following Medicaid members are categorically eligible for QMB benefits:
Note: | If a member is not eligible for categorically or medically needy SSI-related Medicaid through any of these four groups, he or she is not automatically eligible for QMB benefits. |
Example 1: | Kate receives an SSDC payment from Social Security. Due to other unearned income, however, Kate is not eligible for categorically or medically needy SSI-related Medicaid as a DAC. Even though she receives a “DAC” payment, she is not automatically eligible for QMB because she is not eligible for Medicaid through the receipt of SSI or through Special Status Medicaid. |
A 503 assistance group, DAC, and widow or widower, as defined above, have the option of not taking the QMB benefit.
A person is "entitled" to Medicare Part A if he or she meets one of the following conditions:
Example 2: | Mrs. Smith applies for QMB benefits August 15. She has a Medicare card with a Part A begin date of June 1. Since Medicare will pay for Part A services as of June 1, she is "entitled" to Part A at the time of the QMB determination. |
Example 3: | Eleanor's Part A lapsed because she did not work enough quarters for free enrollment, and she could no longer afford the premiums. When she becomes eligible for Medicaid, the state will begin paying her Medicare premiums. |
Example 4: | Pearl was never enrolled in the federal Medicare system. She applies for QMB. Before she can become QMB eligible she must obtain a receipt for conditional eligibility for Part A Medicare. She goes to the SSA office during the January-March enrollment period and is conditionally determined eligible for Part A effective July 1. She applies for QMB at the IM Agency on May 1. She becomes QMB eligible as of July 1. |
The QMB income limit is 100% of the FPL (see Section 39.5 FPL Table).
The method of counting income is based on the SSI method, not on the spousal impoverishment method (see Section 28.1 ADULT HOME AND COMMUNITY-BASED WAIVERS LONG-TERM CARE INTRODUCTION). Calculate QMB net income as follows:
$ Earned income (see Section 15.5 Earned Income)
- $65 and ½ earned income deduction (see Section 15.7.5 $65 and ½ Earned Income Deduction)
+ Unearned income (Social Security income, etc.) (see Section 15.4 Unearned Income)
- Special exempt income (see Section 15.7.2 Special Exempt Income)
- $20 standard deduction
= Net income used to determine QMB eligibility
When counting Social Security income, use the gross Social Security income. Gross Social Security income:
The COLA increase is disregarded for the current year until the month after the new federal poverty limits become effective.
Example 5: | Al is a QMB member. He has income of 99% of the FPL. In January, a COLA increase of $15.00 increases Al's income above 100% of the FPL. The COLA increase is disregarded in any determination of Al's continuing QMB eligibility. On April 1, new QMB income limits are published. Redetermine Al's QMB eligibility in May using the new QMB income limits. At this redetermination, the January COLA increase is applied. |
This page last updated in Release Number: 22-01
Release Date: 04/04/2022
Effective Date: 04/04/2022
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