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DE Medicaid - Income Eligibility for Medicare Related Medicaid

The Income Limits for Medicare Related Medicaid (QMB, SLMB, QI, and QDWI) are based on the Federal Poverty Level (FPL). The definition of income is the same definition used by the SSI program. In determining countable income the Delaware Department of Social Services (DSS) takes into account those income exclusions and disregards used by the SSI program.

Individuals who are not married and/or not living with their spouses, use the income limit for 1 person. Individuals who are married and living with their spouses use the income limit for 2 if their spouses are also eligible for Medicare.

The calculations are fairly straightforward both for a single individual and for a married couple who both get Medicare. The rules are spelled out in the SSI Countable Income topic referenced above.

Calculations Involving Ineligible Spouse

It gets somewhat complicated however, when one person in the couple gets Medicare and the other is not eligible for Medicare. In that case, the income of the ineligible spouse is treated as follows:

If the ineligible spouse's gross income is equal to or less than half the income limit for one QMB, then DSS does not count any of the ineligible spouse's income when determining the financial eligibility of the Medicare spouse.

If none of the ineligible spouse's income is counted toward the Medicare spouse, the income limit for an individual is used to determine eligibility. If DSS deems income from the ineligible spouse to the Medicare spouse, the income limit for a couple is used.

Child Disregard: When determining the countable income of an applicant with children under age 18 and in the home, DSS gives a child's disregard, which is 1/2 of the QMB income limit for one. DSS subtracts any income the child may have from the amount of the disregard. (This means that a disregard cannot be applied if the child has income that exceeds 1/2 of the QMB limit for one.) The child's disregard can only be applied to the ineligible spouse's income not the Medicare spouse's income. DSS applies the child's disregard before applying the $65 and 1/2 remainder disregard.

Note that DSS does not deem children's income to parents. DSS uses a child's disregard to reduce the income that it deems from the ineligible spouse to the Medicare spouse.

See also:

DE Medicaid - Medicare Related Medicaid

DE Medicaid - Resource Eligibility

DE Medicaid - Covered Groups

DE Medicaid - Application Procedures

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Source:

DSS Policy Manual Section 17300.3

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DE Medicaid - Eligibility

DE Medicaid - Overview

DE Division of Social Services - Overview

DE Benefit Information System Overview

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