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COMAR 10.09.24.03

341 State of Maryland Medical Assistance Manual Revised July 2012 Compare the amount of the ineligible spouse‟s income which remains after the appropriate allocations, to the difference between the applicable SSI payment rate for a couple and that for an individual. If the amount is not more than the difference between the applicable SSI payments rate for a couple and that for an individual, there is no income to deem from the ineligible spouse to the Medicare beneficiary. In this case, compare only the Medicare beneficiary‟s own countable income to the QMB income standard for one person to determine if the Medicare beneficiary is eligible for the buy-in coverage.

If the amount of the ineligible spouse‟s income that remains after appropriate allocations is more than the difference between the applicable SSI payment standard for a couple and that for an individual, take the following steps:

o Combine the remainder of the ineligible spouse‟s unearned income with the Medicare beneficiary‟s own unearned income and the remainder of the ineligible spouse‟s earned income with the Medicare beneficiary‟s own earned income. o Apply all appropriate income exclusions and disregards of COMAR 10.09.24.07. o Compare the remainder to the QMB income standard for 2 persons. If the remainder is equal to or less then the QMB income standard for 2 persons, the Medicare beneficiary is eligible for the Buy-in coverage. o If the net countable income exceeds the applicable QMB standard, and the resources are within Schedule MA-2; the Medicare Beneficiary is ineligible for the Buy-in. Recalculate the income for regular MA based on Schedule MA-1 and take appropriate action based on the spend-down provisions. Refer to sections K and L. If, under this same circumstance, the resource exceeds Schedule MA-2, the person is totally ineligible for MA.

Income Deeming Examples

Following are examples of how to deem income from an ineligible spouse to an eligible spouse.

Example 1:

Mr. P, a disabled Medicare beneficiary, applies for the Medicare Buy-in coverage. He lives with his wife and 14-year old son, neither of whom is a Medicare beneficiary. Since Mr. P has requested Buy-in-coverage only, his is a one-person ABD assistance unit. Mr. P. and his son receives OASDI ($350 and $100 monthly, respectively) and Mrs. P is employed and earns $550.00 monthly. The family has countable resources of $3,000, therefore, Mr. P is resource eligible. To determine his income eligibility, the income of his wife is taken into account. Take the following steps to determine if any of the wife‟s income is deemed to be available to Mr. P: