Page 3

Aged, Blind and Disabled Manual Policy Manual Number: 120.010 Section: Medicare Savings Programs Chapter: Qualified Medicare Beneficiary

January 5, 2026 Division of TennCare 3 6. Financial Eligibility Requirements a. Eligibility Determination Group The Eligibility Determination Group (EDG) is governed by the principle of Financially Responsible Relatives (FRR) and the applicant/enrollee’s living arrangements. See the ABD Eligibility Determination Group policy.

b. Income Limit The income limit for receiving benefits in this category is up to 100% FPL.

c. Resource Limit The resource limit for receiving benefits in this category is:

i. $9,950 for an individual; or ii. $14,910 for a couple.

d. Cost-of-Living Adjustment (COLA) Deduction The SSA is responsible for applying COLA to its benefit programs, including Old-Age, Survivors, and Disability Insurance (OASDI), Railroad Retirement Benefits (RRB), and Supplemental Security Income (SSI). If the SSA applies a COLA for a given year, it is applied on January 1st of that year. However, the annual update for FPLs is not typically released until mid- January. This can cause individuals who were previously QMB eligible to become income- ineligible due to their increased Social Security income in the period between the COLA adjustment and the FPL increase.

To address the discrepancy caused by the timing of the COLA and FPL adjustments, QMB enrollees who become income-ineligible in January are provided with a COLA deduction for the months of January through the month following when the FPLs are released. The COLA deduction is equal to the amount of the monthly COLA increase.

e. Budget Mr. Johnson is applying for medical assistance. He is entitled to and enrolled in Medicare Parts A and B and meets all non-financial eligibility requirements. Mr. Johnson has $750 in OASDI payments per month, $150 in unearned income per month, and $0 in earned income. Mr. Johnson is not married.

Mr. Johnson’s net countable monthly income of $880 is less than 100% FPL, $1305 for an EDG size of 1, so he is income eligible in the QMB category.