IM-49 March 21, 2019; IM-30 April 19, 2018; IM-30 March 29, 2017; IM-26 May 9, 2016; IM-22 March 20, 2015; IM-28 March 17, 2006
QMB budgeting procedures follow those of MHABD (refer to Section 0805.015.00 Financial Need) with the following exceptions:
- No deduction from income is allowed for medical insurance premiums on the QMB budget. This includes the SMI premiums for Medicare.
- Income is not rounded down to the nearest whole dollar amount.
For each applicant, the worker must consider gross income of the assistance group, minus all allowable deductions. The resulting net income is compared to the QMB standard (based on assistance group size) to determine eligibility. If net income exceeds the standard, the claimant is not eligible. If net income is equal to or less than the standard, the claimant is eligible.
The budgeting guide below provides examples of how eligibility is determined for QMB. These examples represent income standards effective April 01, 2018 through March 31, 2019.
Refer to MHABD Appendix J Adult Standards chart for the current QDWI income standards.
EXAMPLE #1:
Mr. Smith is age 67. His only income is Social Security of $780.90 per month. He is enrolled in Part A Medicare. His SMI premium of $104.90 per month is deducted from his Social Security check for a net check of $676.00. His wife, age 56, lives with him in the home. She has no income of her own and there are no other household members.
| Gross Income | $780.90 |
| Standard Deduction | $ 20.00 |
| Net Income | $760.90 |
| QMB Standard (2) | $1,372.00 |
| Deduct Net Income | $760.90 |
| Deficit | $611.10 |
Mr. Smith is income eligible for the QMB program.
EXAMPLE #2
Mrs. Jones receives Social Security disability payments of $1203.90 per month. She is enrolled in Part A Medicare. Her Part B premium of $104.90 per month is deducted from her check for a net check of $1099.00. Mr. Jones and their two children, ages 12 and 14, reside in the home. Mr. Jones is employed earning $900.00 per month. He pays a medical insurance premium of $159.00 per month for himself and Mrs. Jones. The children each receive a Social Security benefit of $68.00 per month.
| Earned Income | $900.00 |
| Deduction | $482.50 ($900 + $65 ÷ 2) |
| Remainder | $417.50 |
| Unearned Income | $1,099.00 (SSA for Mrs. J.) |
| Subtotal | $1,516.50 |
| Standard Deduction | $ 20.00 |
| Net Income | $1,496.50 |
| QMB Standard (2) | $1,372.00 |
| Net Income | $1,496.50 |
| Surplus | $124.50 |
Mrs. Jones is not QMB eligible. The needs and income of ineligible children are not considered. Mrs. Jones cannot “spenddown” or use the medical insurance premium to become QMB eligible.
EXAMPLE #3
Mr. and Ms. Black are both over age 65. They are both enrolled in Part A Medicare. Mr. Black has Social Security of $1200.90. Ms. Black has Social Security of $900.90. The SMI premiums are deducted from their checks for net checks of $1096 and $796 respectively. There are no other household members.
| Gross Income | $2,101.80 ($1,200.90 + $900.90) |
| Standard Deduction | $ 20.00 |
| Net Income | $2,081.80 |
| QMB Standard (2) | $1,372.00 |
| Deduct Net Income | $2,081.80 |
| Surplus | $709.80 |
Neither Mr. nor Mrs. Black is eligible for QMB coverage.