Medicaid Policy
Medicaid Policy
A. Who to Include in the Household Size
The household size for a QMB, SLMB, or QI case must include the following individuals:
1. Medicare recipient.
2. Spouse living in the same home. Note: A spouse is living in the same home if either the individual or the spouse is temporarily absent for schooling, vacation, work, or medical care.
a. A spouse who receives Part A Medicare:
i. A spouse who receives Part A Medicare may be included in the coverage or not included in the coverage, depending on the individual's choice.
ii. If the spouse wants coverage, combine the income of both and compare it to the applicable percentage of poverty for two.
iii. If the spouse does not want coverage, their income will be deemed according to the rules in 410-2.
iv. In both situations, use the two-person household size and income limit. Also follow these procedures when one spouse is eligible under a waiver, and both are Medicare Part A eligible.
b. An aged, blind or disabled spouse who does not have Part A Medicare.
i. The income of a spouse who does not have Part A Medicare must be deemed including a spouse eligible under a waiver.
ii. Use a household size of two.
iii. Deem income from the spouse according to the rules in 410-2.
c. If the spouse is not a qualified non-citizen, but is aged, blind or disabled, deem the income and assets of the non-qualified non-citizen spouse using regular deeming rules.
· The non-qualified non-citizen will be included in the household size, but cannot be included on the QMB/SLMB/QI program even if the non-citizen spouse receives Medicare.
d. A spouse who is not aged, blind or disabled if that spouse's deemable income is more than the Spousal Allocation on Table II: (See 410-2.)
i. If the spouse does not meet citizenship/non-citizen status requirements found in 205, deem the income and assets of the non-citizen spouse using regular deeming rules.
ii. If there is deemable income, the non-citizen spouse will be counted in the household size, but cannot be included in the QM coverage.
e. Do not include a spouse who is a resident of a medical institution.
f. If one spouse is receiving Medicaid under a Home and Community Based Waiver and the other does not, first determine eligibility for QMB/SLMB together when both have Medicare Part A and both want coverage.
g. A Medicaid eligible spouse with deemable income must be deemed to the QI program for their spouse, but cannot be included in the QI coverage.
B. Who not to Include in the Household Size
1. Do not include the sponsor of a non-citizen in the household size.
2. Do not include a spouse who is a resident of a medical institution.
3. Do not include a spouse who is living in the same home who does not receive Part A Medicare and is not aged, blind or disabled if that spouse's deemable income is less than, or equal to, the Spousal Allocation on Table II. (See 410-2.)
4. Do not include parents or siblings in the household size of a Medicare recipient child.