Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.98-024 - MS 98-3 - 1998 Federal Poverty Levels

Current through Register Vol. 49, No. 6, June, 2024
2047
Qualified Medicare
			 Beneficiaries Under the Medicare Catastrophic Coverage Act of
			 1988
Section 301 of Public Law 100-360, the Medicare
				Catastrophic Coverage Act of 1988, requires Medicaid buy-in of Medicare
				premiums and coverage of deductibles and coinsurance for Qualified Medicare
				Beneficiaries (QMBs) with income at or below specified percentages of the
				poverty level and resources at or below twice the SSI limit.
2047.1
Scope of
			 Services
Qualified Medicare Beneficiaries under the Medicare
				Catastrophic Coverage Act are not eligible for the full range of Medicaid
				Services. QMBs are eligible only for payment of all Medicare premiums,
				deductibles, and coinsurance.
QMBs will not be eligible for any retroactive coverage as
				QMBs. Coverage of Medicare premiums, deductibles, and coinsurance will begin on
				the first of the month following the month of approval, where an individual is
				found eligible as a QMB. Individuals who apply for coverage as QMBs and who
				have medical expenses in prior
months may be considered in other Medicaid categories
				(including spend-down categories) for the retroactive coverage.
With the exception of spend-down categories, an
				individual may not be certified in a QMB category and in another Medicaid
				category for simultaneous periods. If an individual is eligible in a category
				other than QMB, he will be eligible for and receive the QMB benefits along with
				the other Medicaid benefits (Re MS 2047.8). If an individual could be eligible
				in either a QMB category or a non-QMB category, the individual should be
				approved in the non-QMB category.
Example
: An
				individual is eligible in both categories 41 and 48; the individual will be
				certified in category 41, but will receive full QMB benefits.
An individual may be approved for a spend-down and as a
				QMB for simultaneous periods. Example: An individual applies for QMB coverage
				and for other Medicaid categories on March 1 and has sufficient non-coverable
				medical bills for a spend-down period of March, April, and May. QMB coverage is
				approved on March 30. QMB coverage will begin April 1. For any concurrent
				months of QMB and spend-down eligibility, Medicare premiums may not be
				considered as a non-coverable medical expense.
2047.2
Eligibility
			 Requirements
QMBs must meet the following eligibility
				requirements:
1.
Categorical Relatedness
: A QMB must be aged,
			 blind, or disabled as specified in MS 3321 - 3323.
2.
Medicare Part A
			 Entitlement or Conditional Eligibility
: A QMB must be entitled to
			 or conditionally eligible for hospital benefits under Medicare Part A (Re. MS
			 2047.3). Entitled means that the individual has applied for, is eligible for,
			 and is enrolled in Medicare Part A. Conditionally eligible means that an
			 individual can be enrolled (entitled) for Part A Medicare only on the condition
			 that he/she is eligible for QMB and, thus, eligible for the state Medicaid
			 agency to pay the Part A premium as part of the QMB benefits.
3.
Citizenship or Alien
			 Status
: A QMB must meet the citizenship/alien status requirement
			 as specified in MS 3324.
4.
Enumeration
: A QMB must meet the Social Security
			 Enumeration requirement as specified in MS 1358.
5.
Residency
: A QMB
			 must be an Arkansas resident (Re. MS 2200).
6.
Resources
: A
			 QMB's countable resources may equal but cannot exceed twice the current SSI
			 limitations (Re. MS 3310, #5). The current QMB resource standards are as
			 follows:
Individual
$4,000
Couple
$6,000
Countable Resources are determined according to LTC guidelines
				(Re. MS 3330-3337). There will be no penalty imposed for transfer of
				resources.
* 7.
Income
: The QMB's monthly countable income may equal
			 but cannot exceed 100% percent of the 1998 Federal Poverty Level.
Effective 4/1/98, the monthly income limits are as
				follows:
Individual
$670.83
Couple
$904.17
Countable Income is determined according to LTC guidelines (Re.
				MS 3340-3348). In-Kind Support and Maintenance is considered in QMB
				determinations. For a couple, total monthly countable income will be compared
				to the couple's standard in each case. If only one spouse can be a QMB, then
				the procedures for deeming of income in MS 2111-2111.5 will apply.
Individuals applying for QMB coverage only will not be required
				to apply for SSI if their income is less than the SSI SPA. If an individual
				does not wish to be referred to SSA and does not want to be certified for full
				Medicaid benefits in a non-QMB category, he may be certified for QMB coverage
				only.
8.
Mandatory Assignment of Rights to Medical Support/Third Party
			 Liability
: Re. MS 1350.
9.
CSE Referrals for Minors With
			 Absent Parents
: Re, MS 1355.
2047.3
Medicare Part A
			 Entitlement
A QMB must be entitled to or conditionally eligible for
				hospital insurance benefits under Medicare Part A. Medicare Part A
				beneficiaries include the following groups:
1. Persons age 65 or older who meet one of
			 the following criteria:
a. entitled to
			 monthly Social Security benefits on the basis of covered work under the Social
			 Security Act; or qualified Railroad Retirement beneficiaries; or Verification
			 that the individual's blindness or disability is continuing; that the
			 individual's entitlement to SSA-DIB and Medicare Part A was lost solely due to
			 SGA; that the individual has reenrolled for Medicare Part A; and the effective
			 date of Medicare Part A coverage will be made by requesting the individual to
			 provide any notices received from SSA. If the individual does not have the
			 necessary verification, he/she will be instructed to obtain the needed
			 verification from SSA. The County Office will contact SSA if the individual
			 cannot obtain the necessary verification.
*
			 4.
Income
- Countable
			 income cannot exceed 200% of the Federal Poverty Level. Income will be
			 determined according to LTC guidelines (Re. MS 3340-3348).
Effective 4/1/98, the QDWI countable income limit will
				be:
Individual
$1,341.66
Couple
$1,808.34
5.
Resources
- Countable resources cannot exceed
			 twice the SSI resource limit. Effective 7/1/90, the QDWI resource standards
			 will be:
Individual
$4,000
Couple
$6,000
Resources wi 11 be determined according to LTC guidelines
				(RE. MS 3330-3337). There will be no penalty imposed for transfer of
				resources.
6.
Social Security Enumeration
- the individual
			 must meet the Social Security Enumeration requirements specified in MS
			 1358.
7.
Citizenship or Alien Status
- the individual
			 must meet the citizenship/alien status requirement specified in MS
			 3324.
8.
Residency
- the individual must be an Arkansas
			 resident (Re. MS 2200).
9.
Mandatory Assignment of Rights to Medical Support/Third Party
			 Liability
(Re. MS 1350).
10.
Not Otherwise Eligible
			 for Medicaid
- the individual will not be eligible as a QDWI if
			 eligibility can be established in any other Medicaid category.
Each eligibility factor will be verified by the Service
				Representative and documented in the case
				narrative.
2048.4
Income
			 Determination
The income of an ineligible spouse will be deemed to the
				QDWI applicant (Re. MS 2111-2111.5) and the net income compared to the couple's
				QDWI limit.
The income of an eligible couple will be totaled, and SSI
				exclusions will be given (only one $20 exclusion). The net income for the
				couple will be compared to the couple's QDWI income limit.
The income of QDWI's may vary monthly due to their income
				from employment. MS 3343 will be utilized in the determination and verification
				of earnings from employment.