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West Virginia Income Maintenance Manual Chapter 4

West Virginia Income Maintenance Manual Page 182 Chapter 4 Income

MEDICAID FOR QMB, SLIMB, QI-1 (Categorically Needy, Mandatory) The spenddown provision does not apply for Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB), or Qualifying Individuals (QI-1). 4.12.1 DETERMINING ELIGIBILITY Countable income is determined by subtracting any allowable disregards and deductions from the total countable gross income. Deemed income is addressed in Section 4.12.2 below. Countable income is determined as follows: Step 1: Determine the total countable gross unearned income and subtract the appropriate disregards and deductions. See Section 4.14.2. Step 2: Determine the total countable gross earned income and subtract the appropriate disregards and deductions. See Section 4.14.2. Step 3: Add the results from Step 1 and Step 2 to achieve the total monthly countable income. Step 4: Compare the amount in Step 3 to the QMB, SLIMB, or QI-1 income levels for the appropriate number of persons. See Section 4.14 for SSI-Related deeming procedures. If the amount is less than or equal to the QMB, SLIMB, or QI-1 income levels, the client(s) is eligible. Eligibility for these coverage groups is determined as follows: • QMB – Income is less than or equal to 100% FPL. • SLIMB – Income is greater than 100% FPL, but less than or equal to 120% FPL. NOTE: Recipients of federal benefits such as Retirement, Survivors, and Disability Insurance (RSDI) may receive periodic cost of living adjustments (COLA). For QMB, SLIMB, and QI-1, the RSDI COLAs are disregarded in determining income eligibility for January and any subsequent months prior to the effective month of the state’s Federal Poverty Level (FPL) updates for the year. RSDI and Supplemental Security Income (SSI) increases are handled in accordance with instructions in Chapter 10, Appendices A and B.