Page 38

COMAR 10.09.24.03

337 State of Maryland Medical Assistance Manual Revised July 2012

Background

Federal legislation requires a state‟s Medicaid Program to pay the Medicare B premiums, co- insurances and deductibles for Medicare beneficiaries whose countable income and/or resources are above the applicable amount in a state‟s medically needy income and resources standards but are at or below the applicable amounts in the QMB income and resource standards, provided the applicant meets all other regular Medical Assistance (MA) eligibility requirements.

A Qualified Medicare beneficiary (QMB) is:

A person entitled to Medicare hospital benefits under Part A. (This includes a person entitled to hospital insurance benefits by reason of enrollment in the premium paying Part A program); A person who is not otherwise eligible for MA due to excess or resources; Countable income does not exceed 100 percent of the poverty income guidelines. The poverty income guidelines are issued annually by the U.S. Department of Health and Human Services Countable resources do not exceed twice the applicable SSI resource limit; A blind or disabled Medicare beneficiary who is a parent may request to be included in an FAC unit with their child/children; if they decide to do so, they can still receive QMB benefits

A QMB must also meet the general non-financial requirements or conditions of eligibility for MA of COMAR 10.09.24 such as filing an application, enumeration, citizenship, identity, residency and assignment of rights.

General Explanation

The QMB Buy-in provision is an extension of the current MA Program which provides for State payment of the Medicare Part B premium, co-insurances and deductibles. Buy-in coverage for a person who is determined to be a QMB, as defined in Section B of this part, is for a person who is otherwise ineligible for MA. (NOTE: Medicare Beneficiaries who are eligible for MA are also eligible for the buy-in coverage concurrent with their MA eligibility. The procedures relating to this group of dually eligible persons are included in Part II.)

The general MA policies and procedures apply to the eligibility determination. There are, however some differences that are addressed in this section. The differences are:

Only the Medicare beneficiary is included in the assistance unit; The income and resource deeming methodology from an ineligible spouse (parent);