5.14.3 QMB

5.14.3.1 Entitled to Medicare

5.14.3.2 QMB Income Limit

The following persons are MA recipients who are automatically eligible for QMB benefits.

1. Persons who are receiving or are eligible to receive SSI.
    

2. 503 AGs (5.11.1.1).
    

3. Disabled adult children (5.11.2).
    

4. Widows and Widowers (5.11.3).
    

Widow/widowers, DAC’s and 503’s have the option of not taking the QMB benefit.  See 5.14.12.

If the person does not belong to one of the above named groups, s/he must:

1. Be non-financially eligible for Medicaid.
    

2. Be entitled to Medicare Part A.

5.14.3.1 Entitled to Medicare

A person is "entitled" to Medicare Part A if s/he meets one of the following conditions:

1.  S/he does not have to pay Medicare Part A, and s/he is receiving Medicare Part A services as of the QMB determination.

2. S/he must pay a monthly premium to receive Medicare Part A, and s/he fits one of the following descriptions:
    

3. 1. S/he is a MA recipient and has been enrolled in Medicare sometime in the past.  In this case the State will attempt to enroll him/her in Medicare Part A.  QMB eligibility cannot begin prior to the Part A begin date.

2. S/he is a MA recipient or QMB or SLMB or QDWI applicant and has never been enrolled in the federal Medicare system.  In this case s/he must apply at the local SSA office for Part A Medicare eligibility.  S/he will receive a receipt which entitles him/her to enrollment in Part A on the condition that s/he is found eligible for QMB or SLMB.  The receipt from SSA will have a Part A begin date on it.  QMB OR SLMB or QDWI eligibility cannot begin prior to the Part A begin date.
    

   Example 3: Mrs. Brown 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 1st.  She applies for QMB at the IM Agency on May 1st.  She becomes QMB eligible as of July 1st.

5.14.3.2 QMB Income Limit

The QMB income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. limit is 100% of the federal poverty level (FPL).  See 8.1.6.

The method of counting income is based on the SSI method, not on the spousal impoverishment (5.10) method.  Calculate QMB net income as follows:

$ Earned income (4.1.5)

- $65 and ½ earned income deduction (4.1.3.6)

+ Unearned income (social security income, etc.) (4.1.4)

- Special exempt income (4.1.3.2)

- $20 standard deduction

= Net income used to determine QMB eligibility

When counting social security income, use gross social security income.  Gross social security income:

1. Of a self-payer = the social security check amount + Medicare premiums s/he has paid.
    

2. Of someone for whom the State is paying the premiums = the social security check amount.

Disregard the COLA Cost of Living Adjustment increase for the current year until the month after the new federal poverty limits become effective.

This page last updated in Release Number : 03-02

Release Date : 04/01/03

Effective Date : 04/01/03