Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.24 - Medical Assistance Eligibility
Section 10.09.24.03-3 - Medicare Savings Program Coverage
Universal Citation: MD Code Reg 10.09.24.03-3
Current through Register Vol. 51, No. 19, September 20, 2024
A. Non-Financial and Resource Eligibility for the Medicare Savings Programs. In order to be eligible for the Medicare savings program under §§E"H of this regulation, an individual:
(1) May not be enrolled in Medical Assistance
or the Maryland Children's Health Program under this chapter or under COMAR
10.09.11;
(2) Shall be entitled to
hospital insurance benefits under Medicare Part A, or medical insurance
benefits under Medicare Part B, or both, with or without payment of
premiums;
(3) Shall meet the
non-financial eligibility requirements for Medical Assistance under this
chapter; and
(4) Shall be part of
an assistance unit whose countable resources do not exceed:
(a) For individuals eligible under
§§E"G of this regulation, 3 times the maximum amount allowed by the
Supplemental Security Income program, as adjusted from time to time by the
Social Security Administration, for the number of persons in the assistance
unit; or
(b) For individuals
eligible under §H of this regulation, 2 times the maximum amount allowed
by the Supplemental Security Income program for the number of persons in the
assistance unit.
B. Medicare Savings Program.
(1) The Medical Assistance benefits for
individuals eligible under §§E"H of this regulation are limited to
the Medicare savings program benefits described under those sections of this
regulation.
(2) Current eligibility
for Medicare savings program benefits shall continue until the recipient is
determined ineligible.
C. Application and Redetermination Procedures.
(1) The requirements under this
chapter for applications and redeterminations shall apply for §§E-H
of this regulation except as described in §C(2)-(5) of this
regulation.
(2) Applications and
re-applications for eligibility under this regulation shall be filed at:
(a) The Department or its designee;
(b) The Maryland Department of
Aging;
(c) An area agency on aging;
or
(d) A surrogate organization
approved by the Department.
(3) The initial application may be made at a
face-to-face interview or by mail with an agency defined under §C(2) of
this regulation, as authorized by the Department.
(4) Redeterminations.
(a) Applications for redetermination of
eligibility shall beDepartment or its designee to the recipient or
representative for completion at least once every 12 months.
(b) The recipient or representative shall
return the application to the Department or its designee and indicate:
(i) Any changes that have occurred since the
prior redetermination of eligibility, such as a new address; or
(ii) That there is no new information to
report, by marking "NO CHANGE" on the front of the application.
(c) Upon notice of a change in
circumstances, a redetermination of eligibility under §§E"H of this
regulation shall be completed by the Department or its designee.
(5) Eligibility under
§§E"H of this regulation shall be initially determined and
redetermined by the Department or its designee.
D. Income and Resource Consideration.
(1) Assistance Unit. When financial
eligibility is determined for an applicant or recipient under §§E-H
of this regulation, the countable income and resources of the following
individuals shall be considered and measured against the income and resource
standards specified in this regulation for the number of persons in the
assistance unit:
(a) The applicant or
recipient; and
(b) The applicant's
or recipient's spouse when living in the same household, whether or not the
spouse is eligible for the same benefits under this regulation.
(2) Determining Countable Income
and Resources.
(a) Income and resources shall
be evaluated for §§E"H of this regulation in accordance with the
provisions for aged, blind, or disabled adults residing in the community, as
described under this chapter, in addition to the following resource exclusions:
(i) The cash value of life insurance;
and
(ii) An amount up to $1,500 for
burial or funeral funds, unless included in the annual resource limit for the
full Medicare Part D Low-Income Subsidy (LIS) program.
(b) Cost of Living Disregard. The annual cost
of living increase in Social Security income under Title II of the Social
Security Act shall be disregarded through the month following the month in
which the annual federal poverty level update is published in the Federal
Register.
E. Qualified Medicare Beneficiary (QMB).
(1) An
individual is eligible for QMB benefits if:
(a) All of the requirements of §A of
this regulation are satisfied; and
(b) The assistance unit's net countable
income does not exceed 100 percent of the federal poverty level for the number
of persons in the assistance unit.
(2) Current eligibility for QMB benefits
shall be effective the first day of the month after the month in which QMB
eligibility is determined.
(3)
Retroactive coverage before the month of application is not available for QMB
benefits.
(4) Medicare savings
program benefits for a QMB-eligible person shall include coverage of the
following expenses by the Medical Assistance program:
(a) Monthly premium for Medicare Part
B;
(b) Monthly premium for Medicare
Part A, if the individual, due to insufficient working quarters, is not
entitled to free coverage by the Social Security Administration; and
(c) Medicare Part A and Part B deductibles
and co-insurance for services covered by Medicare, regardless of whether the
services are covered under the Medical Assistance State Plan.
F. Specified Low-Income Medicare Beneficiary (SLMB).
(1) An individual
is eligible for SLMB benefits if:
(a) All of
the requirements of §A of this regulation are satisfied; and
(b) The assistance unit's net countable
income is greater than 100 percent but less than 120 percent of the federal
poverty level for the number of persons in the assistance unit.
(2) Current eligibility for SLMB
benefits shall be effective the first day of the month of
application.
(3) An individual may
qualify for retroactive SLMB benefits for up to 3 calendar months before the
month of application, if the person meets the SLMB eligibility criteria for
each of those prior months.
(4)
Medicare savings program benefits for a SLMB-eligible person shall consist of
coverage by the Medical Assistance program of the monthly premium for Medicare
Part B.
G. Qualifying Individual 1 (QI-1).
(1) An individual is
eligible for QI-1 benefits if:
(a) All of the
requirements of §A of this regulation are satisfied;
(b) The assistance unit's net countable
income is at least 120 percent but less than 135 percent of the federal poverty
level for the number of persons in the assistance unit; and
(c) The individual is not otherwise eligible
for Medical Assistance under this chapter.
(2) Current eligibility for QI-1 benefits
shall be effective the first day of the month of application.
(3) An applicant may qualify for up to 3
calendar months before the month of application for retroactive QI-1 benefits
if:
(a) The individual meets the QI-1
eligibility criteria for each of those prior months under consideration;
and
(b) Each retroactive month is
no earlier than January 1 of the calendar year in which the individual applied
for QI-1 benefits.
(4)
Medicare savings program benefits for a QI-1 eligible person shall consist of
coverage by the Medical Assistance program of the monthly premium for Medicare
Part B.
H. Qualified Disabled and Working Individual (QDWI).
(1) An
individual is eligible for QDWI benefits if:
(a) The individual:
(i) Meets all of the requirements under
§A of this regulation;
(ii) Is
younger than 65 years old;
(iii)
Was determined disabled by the Social Security Administration (SSA) but lost
Social Security benefits solely due to employment;
(iv) Is entitled to enroll in Medicare Part A
under § 1818A of the Social Security Act; and
(v) Is not otherwise eligible for Medical
Assistance under this chapter; and
(b) The assistance unit's net countable
income does not exceed 200 percent of the federal poverty level for the number
of persons in the assistance unit.
(2) SSA shall establish the effective date of
QDWI coverage based on the:
(a) Individual's
date of application for QDWI benefits;
(b) Date of potential QDWI eligibility, as
specified in a letter from SSA to the individual; and
(c) Dates of the next Medicare open
enrollment period.
(3)
Medicare savings program benefits for a QDWI-eligible person shall consist of
coverage by the Medical Assistance program of the monthly premium for Medicare
Part A.
(4) Only the individual who
is identified by SSA as potentially eligible may be eligible for QDWI benefits
in a QDWI assistance unit.
(5)
Retroactive coverage before the month of application is not available for QDWI
benefits.
(6) If an individual
delays in applying for QDWI benefits after notification of potential QDWI
eligibility by SSA, the individual may be required by SSA to pay a premium
surcharge for Medicare Part A, unless the individual is covered by an
employer-based group health plan.
(7) Eligibility for QDWI benefits shall
continue until the earliest of the following dates:
(a) The end of the month after the
Department:
(i) Determines that the individual
is no longer eligible for QDWI benefits in accordance with this regulation;
and
(ii) Sends the recipient a
notice of termination at least 10 days before the effective date;
(b) The end of the month before
the month that the individual becomes:
(i)
Re-entitled to premium-free Medicare Part A; or
(ii) 65 years old;
(c) The date of death; or
(d) The end of the month following the month
that the individual:
(i) Is notified by SSA
that the individual no longer has a disabling impairment; or
(ii) Files a request for termination of QDWI
enrollment.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
