2671.3 Income and Resource Methodologies

The income and resource methodologies of the Medically Needy program shall be applicable in determining eligibility with the exception of the 6 month base period rule and the allowable resource standards. Only the needs, income, and resources of the individual and his or her spouse or parent(s) shall be considered. Income, and resource methodologies are not applicable to active SSI recipients that are entitled to Medicare Part A, as they are deemed automatically eligible for QMB coverage on the basis of their SSI recipient status. (See 2671 above.)

Countable income shall be determined using the independent living disregards as specified in 7240 . This would also apply to persons in LTC living arrangements. Only that person's income would be considered including the amount of any income the person is allocating to a community spouse or other family members in accordance with 8243 (4) or 8244.2 . This allocation would not be deducted in determining countable income for QMB purposes. However, if an individual applies for QMB status who is receiving such allocation, the amount of that allowance must be considered in determining this person's eligibility.

Beginning January 1 of each year, the amount of any cost-of-living increase in Social Security benefits provided for that year shall be disregarded in determining QMB eligibility both for applicants and recipients until the new federal poverty level standards are put into effect.

The general resource guidelines of 5200 shall be applicable in determining countable resources. A transfer of resources under the spousal impoverishment provisions of 8144 and subsections would not be recognized in the QMB determination until the resource has been formally transferred.

A one-month base period shall be applicable to QMB determinations in accordance with 7330 (1) . Total countable income to be considered in the eligibility base period shall be compared against the appropriate monthly standard see F-8, Kansas Medical Standards . Eligibility exists if the countable income does not exceed this level and resources are within allowable levels.

Eligibility for QMB coverage shall be determined separately for the qualifying individual except in instances in which there is more than one qualifying person in the family group.

In such instances, a single determination for all qualifying persons would be applicable. If the qualifying individual is a legally responsible person and the remaining family members request assistance (e.g., MA), his or her needs, income, and resources would also be included in that eligibility determination.

If the person's countable income exceeds the poverty level standard, there is no eligibility for QMB coverage. Persons who are not eligible for QMB may, however, be able to qualify for regular medical benefits based on a cash or spenddown determination.