DHS home page

search
<empty> Staff tools

DHS home | SPD Staff Tools | MSP Manual | E. Financial Requirements
Local Offices News Jobs Forms Data About DHS Policies, rules, guidelines Publications Training

Medicare Savings Programs Manual

E. Financial Requirements

Updated 4/1/18

1. Overview of Assets

Unearned income, earned income and resources are assets. For QMB/SMB/SMF, treat assets as follows unless otherwise specified in other administrative rule(s): Effective 1/1/16, all resources are excluded in the QMB/SMB/SMF programs, so an asset is either counted as income or excluded in any given month. "Excluded” means an asset is not counted as either income or as a resource. When determining financial eligibility, count all income not excluded or otherwise considered unavailable. Exclude all assets as resources.

For information on specific assets, see Counting Client Assets A.2.

In order to be excluded as income, funds must be identifiable, but this does not mean that the funds have to be physically apart from other assets (see 461-140-0070).

For information on the availability of income, see 461-140-0040. Unavailable income does not affect a benefits group’s eligibility or benefit level.

461-140-0010

2. Income Limits

The adjusted income standards are as follows.

QMB-BAS Adjusted Income Standard 100% FPL

No. in Need Group
Amount
1
$1,012
2
1,372
3
1,732
4
2,092
5
2,452
6
2,812
7
3,172
8
3,532
9
3,892
10
4,252
Each additional person
360


461-155-0290

QMB-DW Adjusted Income Standard 200% of FPL

No. In Need Group
Amount
1
$2,024
2
2,744
3
3,464
4
4,184
5
4,904
6
5,624
7
6,644
8
7,064
9
7,784
8
8,504
Each additional person
720


461-155-0291

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

No. In Need Group
Amount
1
$ 1,214
2
1,646
3
2,078
4
2,510
5
2,942
6
3,374
7
3,806
8
4,238
9
4,670
10
5,102
Each additional person
432


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

No. in Need Group
Amount
1
$ 1,366
2
1,852
3
2,338
4
2,824
5
3,310
6
3,796
7
4,282
8
4,768
9
5,254
10
5,740
Each additional person
486

461-155-0295

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.

For information on lump sum and periodic income policy see Counting Client Assets A.4 and A.5, respectively.

3. Income Deductions

Use this section to determine financial eligibility and adjusted income for all MSP 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 and QMB-SMF programs, 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:

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

4. Resource Limits

All resources are excluded for QMB-BAS, QMB-SMB, and QMB-SMF effective 1/1/16.

Use of Resources in Determining Financial Eligibility 461-160-0010

Resource Limits 461-160-0015

5. Prospective Eligibility and Budgeting

arrowClick here for definitions used in determining prospective eligibility and budgeting

To use prospective eligibility and budgeting:

Note: We anticipate and average prospective income in accordance with the budgeting rules for self-employment income (see below and OAR 461-150-0095).

 

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

Prospective Budgeting of Variable Earned and Unearned Income

Income that can be defined as variable (see OAR 461-001-0000) should be averaged and converted to a monthly amount, except when a new source of variable income begins in the initial month, or in a month for which the individual is requesting retroactive benefits. In that case, the amount counted is the actual amount received or the amount expected to be received in that month.  See CCA A.6 for examples of calculating and budgeting variable income.

461-150-0080

Prospective Budgeting of Periodic Income

Periodic income is received on a regular basis but less often than monthly.  It is not converted or averaged; instead it is counted in the month it is received.  This means that benefits may have to be reduced or closed (depending on the program) during that month, but only if the amount does not vary.  Because of MAGI and due process, by the time the first referral is made and returned by 5503, it will be too late to take a closure action; however, the referral is only needed once.  After the initial referral, the branch can close for the month in question as needed with timely notice (narrate that MAGI was already addressed).  Remember you can screen out most individuals MAGI without referral to 5503 prior to reducing! See the APD MAGI Manual C.2 for more information.

If the amounts vary, the reporting requirements apply.  If the client reports the amount ahead of time and there is time to close or reduce with a timely notice (remember the MAGI referral must be done the first time) then close or reduce for that month as needed. If the client exercises his/her right to report the change within 10 days of receipt, there is no time to take action on the change and benefits will remain as-is.   

461-140-0110

Averaging and Anticipating Self-employment Income

Income from self-employment is averaged over 12 months in accordance with 461-150-0095.  If past income is not representative of future income, the client hasn’t been in business very long, or when a substantial change is expected in next year's income, income can be anticipated.  See OAR 461-150-0095 to determine how to anticipate income and costs. For more information about and examples of averaging and anticipating self-employment income, see Section C of Counting Client Assets

Note:  Contract income (such as educational income) is no longer addressed in the self-employment rule; nor is it pro-rated.  It is treated as earned income and budgeted based on when it is received (i.e. variable, periodic, stable, etc.).

Prospective budgeting of self-employment income 461-150-0095

If you have a disability and need a document on this Web site to be provided to you in another format, please contact the Office of Document Management (ODM) at 503-378-3486 or by e-mail at dhs.forms@state.or.us.
If you have questions about DHS or problems getting DHS services, send e-mail to dhs.info@state.or.us. If you have comments about this site, send e-mail to spd.web@state.or.us.
Oregon Department of Human Services
500 Summer St. NE E02, Salem, OR 97301-1073
Phone: (503) 945-5811
Toll-free: (800) 282-8096 (V/TTY)