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- 3. Determine total gross earned income. 4. Subtract any balance of the general exclusion not offset by unearned income. 5. Subtract the work expense exclusion of $65. 6. Subtract one half (1/2) of the remaining earned income after the above deductions. 7. Determine the total countable income by adding the total unearned and earned income. 8. Compare the total countable income to the income limit for the appropriate Medicare Beneficiaries category. If countable net income is less than or equal to the income limit, the customer is QMB/SLMB/QI1/QDWI eligible. NOTE: Use the income limit for a COUPLE if spousal income was computed or deemed. Examples: The following are examples to help clarify this eligible category: 1. Applicant applies 12/3 as a state institutional case and is currently enrolled in Medicare Part A. The customer cooperates and is determined eligible as a state institutional case. Because this customer has Medicare Part A, the case manager must also determine whether the customer is eligible for QMB coverage. If the customer's income and resources meet QMB criteria, they will qualify for both Medicaid and QMB coverage. 2. Applicant applies 12/3 and has $250 SSA disability income. The customer has not applied for SSI, but is probably eligible. The customer meets all the other requirements of a QMB. Request the customer to apply for SSI and give the normal time limit for applying; however, do not delay QMB eligibility once verifications for QMB are received. The case would be future actioned for the SSI information. If the customer fails to cooperate in applying for SSI, or is determined ineligible, the case will remain open as a QMB only case as long as the customer continues to meet the criteria. If the customer is approved for SSI, the case will be converted to an SSI case effective with the month of SSI eligibility (this could include prior med). Additionally, if the person also has Part B Medicare, send Form 1056 to Eligibility and Payments in the Carson City Administrative Office (CCAO). Also Buy-In coverage can begin with the first month of SSI eligibility. 3. Applicant applies and is approved for QMB coverage. Sometime after approval, the customer enters the hospital for 7 days. The case continues as QMB and no patient liability is determined, UNLESS the customer qualifies as a state institutional case Division of Welfare and Supportive Services E-235.2 Medical Assistance Manual MAABD INCOME AND BUDGETING MTL 09/24 NOV 24 Budgeting – Specific Instructions