Identification Number:
HI 00815 TN 21
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODEPP
Title:State Enrollment of Eligible Individuals
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 008 – Requirement for Entitlement and Termination
Subchapter 15 – State Enrollment of Eligible Individuals
Transmittal No. 21, 02/01/2019

Audience

PSC: BA, CA, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CR, EIE, ERE, FCR, PETL, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, DSE, LCC, PAS, PETE, PETL, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

HI 00815.023 Medicare Savings Programs Income Limits

Updated 2019 income and resource limits.

HI 00815.023 Medicare Savings Programs Income Limits

A. Background

The monthly income limits for the Medicare Savings Programs (MSPs) are based on a percentage of the Federal Poverty Level (FPL) rates that are published each year in the Federal Register. All of the 2019 rates listed below include the $20 general income exclusion. This allows interviewers to compare gross income to the monthly income limits to make a quick assessment of potential eligibility.

The monthly income limits shown are effective from January 1, 2019 through December 31, 2019.

B. Policy

The Qualified Disabled Working Individual (QDWI) rate is based on the maximum countable earned income an individual or couple may have and qualify for. We have factored in both the Supplemental Security Income (SSI) $20 general income exclusion and the SSI earned income exclusion ($65 plus ½ the remainder); these SSI exclusions are used in the MSPs. The QDWI limits assume that people who ask about this program are likely to be working.

If someone asks about the other MSPs (QMB, SLMB, QI) and has earned income, apply the SSI earned income exclusions.

Please remember that only the State can determine if an individual qualifies for coverage under one of the MSPs. Even if individuals or couples are slightly over the income or resource limit, refer them to the State. States have some flexibility in excluding some income and resources. You should be aware that several States may even disregard all resources for individuals or couples in certain categories. The new 2019 — 2020 asset resource limits are also reflected below.

NOTE: CMS rounds up to the nearest dollar when computing the monthly income limits.

C. Procedure

1. QMB Monthly Income Limits for 2019 (up to 100% FPL+ $20)*

Individual

Couple

All States except Alaska and Hawaii.

$1,061

$1,430

Alaska

$1,320

$1,781

Hawaii

$1,219

$1,642

Asset Limits

$7,730

$11,600

See HI 00801.139 and TC 23001.050.

2. SLMB Monthly Income Limits for 2019 (less than 120% FPL+ $20)*

 

Individual

Couple

All States except Alaska and Hawaii:

$1,269

$1,711

Alaska

$1,580

$2,133

Hawaii

$1,458

$1,966

Asset Limits

$7,730

$11,600

See TC 23001.060.

3. QI Monthly Income Limits for 2019 (less than 135% FPL+ $20)*

 

Individual

Couple

All States except Alaska and Hawaii:

$1,426

$1,923

Alaska

$1,775

$2,398

Hawaii

$1,638

$2,210

Asset Limits

$7,730

$11,600

See TC 23001.070.

4. QDWI Monthly Income Limits for 2019 (up to 200% FPL+ $65+$20)*

($65= monthly SSI earned income exclusion.)

 

Individual

Couple

All States except Alaska and Hawaii:

$4,249

$5,722

Alaska

$5,285

$7,129

Hawaii

$4,879

$6,572

Asset Limits

$4,000

$6,000

* $20 = monthly SSI general income exclusion.

See HI 00801.170 and TC 23001.080.


HI 00815 TN 21 - State Enrollment of Eligible Individuals - 2/01/2019