QMB C. Eligibility Groups

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QMB Program Manual

C. Eligibility Groups

Effective 4/1/11

1. Overview

This section has rules which determine the membership in the five eligibility groups. They are:

Household
Filing
Financial
Need
Benefit

This section tells you how many people in the household are in the each of the eligibility groups. This determines whose money is counted, which income and resource standards are used and who gets QMB benefits.

2. Household Group

The household group is the people who live together with or without benefit of a dwelling. For homeless people, the household group is the people who consider themselves living together. The people in the household group who apply for benefits are called applicants.

A separate household group is established for people who live in the same dwelling as another household group, if a landlord/tenant relationship exists.

People who live with more than one household group during a calendar month are members of the household group where they spend 51 percent or more of their time.

People gone from the household for 30 days or more are no longer part of the household, except individuals in an acute care medical faclity remain in the household group unless they go into long-term care.

For QMB, the household group consists of the client and their spouse, even if the spouse does not meet all nonfinancial eligibility requirements.

Note: Notice that the QMB HH group for nonstandard living arrangements is different from that of OSIPM. If you have a client who is in the same building as their spouse, even if they are receiving services, they are in the same HH group as their spouse for QMB. They would be in separate HH groups for OSIPM. See WG.1 for examples of nonstandard living situations.

461-110-0210

3. Filing Group

The filing group is the people from the household group whose circumstances are considered in the eligibility determination process.

If the filing group does not include at least one applicant who meets all nonfinancial eligibility requirements, the group is ineligible. Clients must provide information needed to determine who must be in the filing group.

When a household member is in more than one filing group for the same program, the filing groups must be combined, unless specified otherwise in administrative rule.

461-110-0310

The filing group consists of each applicant and the following household members:

The spouse of each applicant.
Each parent of each child, if the children are applying and are not assumed eligible.
Children of the applicant, if the applicant wants to include these children in the need group.

461-110-0410

Note: Clients would want to include a child if the child had no or little income and the parent was over the income standard without them.

4. Financial Group

For QMB all the members of the filing group are also members of the financial group. The financial group determines whose income and resources count in determining eligibility and benefits.

Financial Group; Overview: 461-110-0510
Financial Group; QMB: 461-110-0530

5. Need Group

The need group is the people whose basic and special needs are used in determining eligibility and consists of each member of the financial group.

461-110-0630

6. Benefit Group

The benefit group is the people who receive benefits.

For people not assumed eligible, the benefit group consists of the people from the need group who meet all the following:

All nonfinancial eligibility requirements.
Have resources below the resource limit.
Have income below the income limits.

For people assumed eligible, the benefit group consists of the people who are in the benefit group of the program used to assume eligibility.

461-110-0750

Note: People are assumed eligible for QMB-BAS if they receive SSI and Medicare Part A. See 461-135-0010 for assumed eligibles.

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