Determining Eligibility for Qualified Medicare Beneficiaries

PURPOSE: This rule establishes the principles used in determining eligibility for Qualified Medicare Beneficiary coverage on the basis of income, resources and Part A Medicare entitlement. PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. Therefore, the material which is so incorporated is on file with the agency who filed this rule, and with the Office of the Secretary of State. Any interested person may view this material at either agency’s headquarters or the same will be made available at the Office of the Secretary of State at a cost not to exceed actual cost of copy reproduction. The entire text of the rule is printed here. This note refers only to the incorporated by reference material. (1) An eligible Qualified Medicare Beneficiary shall— (A) Be entitled to and enrolled in Hospital Insurance under Part A of Medicare, as described in Section 1811 of the Social Security Act; (B) Not possess available resources, as defined in 13 CSR 40-2.030, in excess of twice the individual resource maximum of the federal Supplemental Security Income (SSI) program for a single person or, if married and actually living with the spouse, the available resources of either the Qualified Medicare Beneficiary or the spouse, or both, shall not exceed twice the couple resource maximum of the federal SSI program, as cited at Section 1611(a)(3) of the Social Security Act; (C) Not have adjusted gross income in excess of one hundred percent (100%) of the federal poverty level beginning January 1, 1991. For a single person, the adjusted gross income limitation shall be the applicable percentage of the poverty level for one (1) person. For a married couple living together, the adjusted gross income limitation shall be the applicable percentage of the poverty level for two (2) persons. For a married couple living together with an eligible dependent child, when one (1) of the parents is also eligible, the adjusted gross income limitation shall be the applicable percentage of the poverty level for three (3) persons. When an eligible dependent child lives with an ineligible parent(s), a portion of the income of the parent(s) shall be deemed to be the child’s and, in combination with the child’s own income, be compared to the adjusted gross income limitation for a single person. In determining adjusted gross income, the following exemptions will be applied to gross income: 1. If the income is earned or unearned, an amount of twenty dollars ($20) may be excluded from the gross; 2. The full amount of any SSI payment will be excluded; and 3. If the income is earned, the twenty dollar ($20) exclusion in paragraph (1)(C)1. will be applied, plus the first sixty-five dollars ($65) and one-half (1/2) of the remainder of all earned income will be excluded. If a person is a student and is under the age of twenty-two (22), the amount of the school expense will be excluded from any earned income; (D) Not have transferred property without receiving fair and valuable consideration. Transfers which occur prior to July 1, 1989 shall cause periods of ineligibility for assistance in accordance with section 208.010.2(1), RSMo. Transfers which occur after June 30, 1989 shall cause periods of ineligibility in accordance with section 208.010.6., RSMo; and (E) Not possess, prior to October 1, 1989, equity in total property in excess of the maximum set out in section 208.010.2(5), RSMo. (2) Eligibility for Qualified Medicare Beneficiary assistance may not begin until the month following the month the Division of Family Services completes the determination of eligibility. AUTHORITY: section 207.020, RSMo 1986.* Emergency rule filed July 5, 1989, effective July 15, 1989, expired Nov. 12, 1989. Original rule filed July 5, 1989, effective Oct. 12, 1989. Emergency amendment filed Dec. 20, 1989, effective Dec. 30, 1989, expired April 29, 1990. Amended: Filed Feb. 15, 1990, effective May 11, 1990. Emergency amendment filed Dec. 18, 1990, effective Jan. 1, 1991, expired April 30, 1991. Amended: Filed Jan. 25, 1991, effective July 8, 1991. *Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986.