This section has rules which determine the membership in the five eligibility groups. They are:
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.
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.
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.
The filing group consists of each applicant and the following household members:
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
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.
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:
For people assumed eligible, the benefit group consists of the people who are in the benefit group of the program used to assume eligibility.