Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.96-008 - Federal Poverty Levels

Current through Register Vol. 49, No. 6, June, 2024
Click here
				to view image
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
			 Re!atedness
: 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 1995 Federal Poverty Level.
Effective 4/1/96, the monthly income limits are as
				follows:
Individual
$645.00
Couple
$863.33
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.