QMB E. Financial Requirements

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QMB Program Manual

E. Financial Requirements

Effective 4/01/13

1. Overview of Assets

For the QMB and SMB programs, treat assets as follows unless otherwise specified in other administrative rule(s): An asset is either counted as income, counted as a resource, or excluded in any given month.”Excluded” means an asset is not counted as either income or as a resource. Unearned income, earned income and resources are assets. When determining financial eligibility, count all assets not specifically excluded.

An asset that is counted as income is excluded as a resource in that budget month. Count any remaining amounts as a resource the following month. Assets not available per 461-140-0020 and 461-140-0040 do not affect a benefits group’s eligibility or benefit level.

461-140-0010

For information on the availability of assets, see Counting Client Assets A.2.

Treatment of Excluded Assets. Exclude cash and money in bank accounts if:

The money is from an excluded payment.
It is kept separate from counted resources (if it is not separate exclude it for six months from the date it is combined).

If the excluded cash is converted into a noncash resource, treat it according to the policy for the item.

Note: If a client receives an LDS from their spouse, that amount is counted as unearned income for the QMB program. Code it as OTH on CMS.

461-140-0070

2. Income Limits

The adjusted income standards are as follows.

QMB-BAS Adjusted Income Standard 100% FPL

No. in Need Group	Amount
1	$958
2	1,293
3	1,628
4	1,963
5	2,298
6	2,633
7	2,968
8	3,303
9	3,638
10	3,973
Each additional person	335

461-155-0290

QMB-DW Adjusted Income Standard 200% of FPL

No. In Need Group	Amount
1	$1,915
2	2,585
3	3,255
4	3,925
5	4,595
6	5,265
7	5,935
8	6,605
9	7,275
8	7,945
Each additional person	670

461-155-0291

SMB Adjusted Income Standard
Income greater than 101% but less than 120% FPL

No. In Need Group	Amount
1	$ 1,149
2	1,551
3	1,953
4	2,355
5	2,757
6	3,159
7	3,561
8	3,963
9	4,365
10	4,767
Each additional person	402

SMF Adjusted Income Standard
Income equal to or greater than 120% but less than 135% FPL

No. in Need Group	Amount
1	$ 1,293
2	1,745
3	2,198
4	2,650
5	3,102
6	3,554
7	4,007
8	4,459
9	4,911
10	5,363
Each additional person	453

461-155-0295

Protected eligibility from SSA COLAs - Each year, from January 1st until the new program income standards are put into effect, all ongoing clients in any QMB subprogram have protected eligibility from the annual SSA Cost of Living increase (COLA). This includes those requiring a redetermination. The mainframe computer will have an inflated Income Standard programmed to keep clients from going No Action (NA) and having their case closed during this period of time. When the new income changes are instituted (2 months after the new poverty level is published in the Federal Register), all cases will be compared to the new standards and some may go NA at this time. The standards usually change in April of each year, but it is dependent upon when the Federal Government publishes the new Poverty Level standards.

Shelter-in-kind standards. For a definition of shelter-in kind see 461-145-0470. If a client receives shelter-in-kind, the following amounts are added to the adjusted income, then compared to the appropriate standard above. Shelter-in-kind standards can be found in 461-155-0300.

Note: If a client is paying a portion of rent and utilities this rule does not apply.

For information on periodic and lump sum income policy see Counting Client Assets A.

3. Income Deductions

Use this section to determine financial eligibility and adjusted income for all QMB clients. Determine which income deductions to allow and calculate adjusted income by subtracting allowable deductions from countable income.

In the QMB-BAS program, a client is eligible if his or her adjusted income is equal to or less than the QMB adjusted income standard.

In the QMB-SMB program, a client is eligible if his or her adjusted income is less than the adjusted income standard.

Allow income deductions from the financial group's income in the following order:

One standard deduction of $20 (see note below).

One standard earned income deduction of:
- $65 for clients who are not blind
- $85 for clients who are blind
Allow an additional income deduction for documented impairment-related work costs for QMB clients under age 65.
One half of the remaining earned income.
Deductions under a Plan for Self Support for QMB clients under age 65.

Note: Subtract the $20 standard deduction from unearned income. If the financial group has no unearned income or less than $20 in unearned income, subtract the remainder from any earned income.
Note: The financial group is made up of the client and their spouse (and children, if advantageous), whether that spouse is eligible for Medicaid or not.

Financial eligibility: 461-160-0540
Adjusted income: 461-160-0552

4. Resource Limits

Use countable resources (461-140-0020) to determine eligibility as follows: For QMB, a need group is not eligible for benefits if the financial group has countable resources above the need group resource limit.

461-160-0010

The resource limit is $7,080 for a one-person need group or $10,620 for a need group containing two or more people.

461-160-0015

5. Prospective Eligibility and Budgeting

Click here for definitions used in determining eligibility and budgeting

To determine when to use prospective eligibility and budgeting:

For the initial month, use prospective eligibility and budgeting. Exclude money received from a nonrecurring source before the date of application. If any money remains after the date of application, count it as a resource.
For ongoing months:
- use prospective eligibility and budgeting for income that can be anticipated under 461-150-0070, 461-150-0080, 461-150-0090.

For prospective eligibility and budgeting:

The budget month and payment month are the same.
The client and Department jointly anticipate the client's income based on the income already received and the income the client expects to receive.
Prospective budgeting is used for annualized income and prorated educational income.
When prospective budgeting is used and the actual income differs from the anticipated income:
- If the anticipated income exceeds the actual income, a client is not entitled to a benefit supplement.
- If the actual income exceeds the anticipated income, there may be a client-error overpayment.

Prospective: 461-150-0020
QMB Specific: 461-150-0050

Prospective Use of Income That Varies/Averaged: Depending on how often income is paid and the type of income, there are different methods for anticipating how much to count each month. The following explains these methods.

For stable income that is received in the same amount once a month, use that monthly amount.

For stable income that is received in the same amount once a week, convert it to a monthly amount by multiplying by 4.3. Similarly, for stable income that is received in the same amount once every other week, convert it to a monthly amount by multiplying by 2.15.

Clients with income that varies monthly will have their income calculated as follows:

If the client receives an hourly wage, determine with the client the average number of hours the client works each week. If their weekly hours in the past month do not represent the future, use the weekly hours that the client would work in the months of the certification period. Document the reason for the change in hours, especially when the weekly hours are significantly different from the past. Calculate the monthly income by multiplying the hourly wage by the average number of hours, plus tips or commissions, if any, that the client may receive and times the amount by 4.3. Document the calculation. The following is an example of the narration of the calculation:

Marcia reported on August 21 that she is working at McDonalds. Start date: August 17, paid $8.40 an hour and expects to work 25 hours a week. The first pay date will be August 28 for pay period ending August 22. EML = $645 ($8.40 X 25 = 210 X 4.3 = $903). Too late to send notice for September, send FS reduction notice effective October 1.

If the client does not receive an hourly wage or receive income from work done on an hourly basis, e.g. piece work and certain farm work, the client’s prospective income is computed as follows:

If the client’s previous income is indicative of the income the financial group will receive during the redetermination, the financial group’s income from the preceding two months is added to the income for the current month and divided by three.
If past income is not representative of what income is expected to continue, the worker and client jointly determine what income is reasonable to anticipate for the redetermination period.

461-150-0080

Prospective Use of Income That Varies, Not Averaged/. An individual receiving periodic income may not be eligible for QMB during the months in which income is received and may be eligible for QMB during the months in which income is not received. In instances in which the periodic income is predictable, such as for school district employees, use prospective eligibility to change the program to QMB in the months that it is known the individual will not be receiving income and is eligible for QMB benefits. Eligibility should be checked for SMB/SMF in the months in which the person is receiving income and not eligible for QMB benefits. A timely continuing benefit decision notice must be sent when the program changes from QMB to SMB/SMF to notify the individual of a reduction in benefits.

For example, an individual works for the school district and receives income only during the school year (September-June). The individual may be eligible for SMB/SMF benefits during the months in which they are working and receiving income and may be eligible for QMB benefits during the months in which they are not working and not receiving income from this source. If it is known that the individual will be eligible for QMB beginning in June and ending in September, using prospective eligibility, the case should be coded as QMB effective June 1. The case should then return to SMB/SMF coding effective October 1 and a timely continuing benefit decision notice should be mailed.

461-140-0110

Annualizing Contracted or Self-employment Income

Income from self-employment, including contract income while self-employed, is annualized in accordance with 461-145-0910 unless past income is not representative of future income or when a substantial change is expected in next year's income, income is not annualized. In this case, anticipated income and costs are used to determine the countable income.

Contract income that is not the annual income of the financial group and not paid on an hourly or piecework basis is prorated over the period the income is intended to cover.

461-150-0090

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