WAC 182-517-0100 Federal medicare savings programs.

Effective July 23, 2016

  1. Available programs.  The agency offers eligible clients the following medicare savings programs (MSPs):
    1. The qualified Medicare beneficiary (QMB) program;
    2. The specified low-income medicare beneficiary (SLMB) program;
    3. The qualified individual (QI-1) program; and
    4. The qualified disabled and working individuals (QDWI) program.
  2. Eligibility.
    1. To be eligible for an MSP a person must:
      1. Be entitled to medicare Part A;
      2. Be a U.S. citizen, U.S. national, qualified American Indian born abroad, or a qualified alien who satisfies or is exempt from the five-year bar under WAC 182-503-0535;
      3. Not exceed the income limits in (d) of this subsection; and
      4. Not exceed the resource limits in (e) of this subsection.
    2. To be eligible for QDWI, a person must be under age sixty-five.
    3. Except as provided under (d) and (e) of this subsection, MSPs follow the income, resource, and deeming rules for SSI-related persons in chapter 182-512 WAC.
    4. Income limits.
      1. If a person's countable income is less than or equal to the federal poverty level (FPL), the person may qualify for the QMB pro­gram.
      2. If a person's countable income is over the FPL, but does not exceed one hundred twenty percent of the FPL, the person may qualify for the SLMB program.
      3. If a person's countable income is over one hundred twenty percent of the FPL, but does not exceed one hundred thirty-five per­ cent of the FPL, the person may qualify for the QI-1 program.
      4. If a person's countable income is over one hundred thirty- five percent of the FPL, but does not exceed two hundred percent of the FPL, the person may qualify for the QDWI program.
    5. Resource limits.
      1. The resource limit for the QMB, SLMB, and QI-1 programs may be found at www.hca.wa.gov/health-care-services-and-supports/program-standard-income-and-resources.
      2. The resource limit for the QDWI program is $4,000 for a sin­gle person and $6,000 for a married couple.
    6. When calculating income under this section:
      1. The agency subtracts client participation from a long-term care client's countable income under WAC 182-513-1380, 182-515-1509, or 182-515-1514.
      2. The agency counts the annual Social Security cost-of-living increase beginning April 1st each year.
    7. Relationship of MSPs to other medicaid programs:
      1. A client eligible for another medicaid program may also receive QMB or SLMB coverage.
      2. A client eligible for another medicaid program is not eligible for QI-1 or QDWI.
  3. Covered costs.
    1. The QMB program pays:
      1. Medicare Part A and Part B premiums using the start date in WAC 182-504-0025; and
      2. Medicare coinsurance, copayments, and deductibles for Part A, Part B, and medicare advantage Part C, subject to the limitations in WAC 182-502-0110.
    2. If the client is eligible for both SLMB and another medicaid program:
      1. The SLMB program pays the Part B premiums using the start date in WAC 182-504-0025; and
      2. The medicaid program pays medicare coinsurance, copayments, and deductibles for Part A, Part B, and medicare advantage Part C sub­ject to the limitations in WAC 182-502-0110.
    3. If the client is only eligible for SLMB, the SLMB program covers medicare Part B premiums using the start date in WAC 182-504-0025.
    4. The QI-1 program pays medicare Part B premiums using the start date in WAC 182-504-0025 until the agency's federal funding al­lotment is spent. The agency resumes QI-1 benefit payments the beginning of the next calendar year.
    5. The QDWI program covers medicare Part A premiums using the start date in WAC 182-504-0025.
  4. Medicaid eligibility may affect MSP eligibility:
    1. QMB and SLMB clients may receive medicaid and still be eligi­ble to receive QMB or SLMB benefits.
    2. QI-1 and QDWI clients who begin receiving medicaid are no longer eligible for QI-1 or QDWI benefits, but may be eligible for the state-funded medicare buy-in program under WAC 182-517-0300.
  5. The FPL standards are found at: www.hca.wa.gov/health-care-services-and-supports/program-standard-income-and-resources.
  6. A person who disagrees with agency action under this section may request an administrative hearing under chapter 182-526 WAC.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.