All Medicaid Programs |
Obsolete Policy |
No Previous Policy
A. Who MUST be Included in the Household Size?
The household size for a QMB, SLMB, or QI case must include the following individuals:
1. The Medicare recipient.
2. A spouse living in the same home who receives Part A Medicare: A spouse who receives Part A Medicare may be included in the coverage or not included in the coverage, depending on the client's choice. If the spouse wants coverage, combine the income of both and compare it to the applicable percentage of poverty for two. If the spouse does not want coverage, their income will be deemed according to the rules in Sec. 427-2. 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.
3. An aged, blind or disabled spouse who does not have Part A Medicare. The income of a spouse who does not have Part A Medicare must be deemed including a spouse eligible under a waiver. Use a household size of two. Deem income from the spouse according to the rules in Sec. 427-2.
If the spouse is not a qualified alien, but is aged, blind or disabled, deem the income and assets of the non-qualified alien spouse using regular deeming rules. The non-qualified alien will be included in the household size, but cannot be included on the QMB/SLMB/QI program even if the alien spouse receives Medicare.
4. A spouse living in the same home who is not aged, blind or disabled IF that spouse's deemable income is more than the Spousal Allocation on Table II: (See Sec. 427-2.) If the spouse does not meet citizenship/alien status requirements found in 205, deem the income and assets of the alien spouse using regular deeming rules. If there is deemable income, the alien spouse will be counted in the household size, but cannot be included in the QM coverage.
Note: A spouse is living in the same home if either the client or the spouse is temporarily absent for schooling, vacation, work, or medical care. The only exception is this: do not include a spouse who is a resident of a medical institution. 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. A Medicaid- eligible spouse with deemable income must be deemed to the QI program for his or her spouse, but cannot be included in the QI coverage. The income limits used for QMB/SLMB/QI programs are the applicable percentage of the federal poverty level. See Table VII.
B. Who Must NOT be Included in the Household Size?
1. DO NOT include the sponsor of an alien 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 Sec. 427-2.)