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SD Medicaid for Low-Income Medicare Beneficiaries

Medicare recipients with low incomes and limited resources are eligible for one of the programs that offer limited Medicaid medical assistance (in which Medicaid pays Medicare co-payments and deductibles and/or Medicare premiums).

These programs are often called "Medicare-Related Medicaid":

·      Qualified Medicare Beneficiary (QMB): Pays for the Medicare Part A and Part B premium, deductibles and co-insurance.

·      Special Low-Income Medicare Beneficiary (SLMB): Pays for the Medicare Part B premium only.

·      Qualified Individual-1 (QI-1): Pays for the Medicare Part B premium only.

·      Qualified Working Individual (QWI): Pays for Medicare Part A premium only. (QWI is only for those who were terminated from hospital insurance benefits (Medicare Part A) due to employment, and then purchased Part A.)

Financial Eligibility

Resources: The Resource Limit for all of the above programs is $4,000 for an individual and $6,000 for a couple. Resources include items such as checking and savings accounts and certificates of deposit.

NOTE: Disposal of resources - The value of resources disposed of and no longer owned by the individual are not considered. (Rules against the transfer of resources do not apply.)

Income: The income limits are based on the relationship between your Countable Income and the Federal Poverty Level (FPL) for your family size.

NOTE: South Dakota has chosen to include all family members (including children) when determining the FPL family size. The incomes of only the individual and spouse, however, are counted - not the incomes, if any, of children.

The income limits for each of the programs are:

·      QMB: Countable Income must not exceed 100% FPL.

·      SLMB: Countable Income must be less than 120% FPL.

·      QI-1: Countable Income must be at least 120% and less than 135% FPL.

·      QWI: Countable Income must not exceed 200% FPL.

Sources:

http://www.state.sd.us/social/MedElig/Medicare/index.htm, http://www.state.sd.us/social/MedElig/ssi/Working.htm, and http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=67:46 (67:46:01:02 (18,19 & 20) - Eligibility requirements and 67:46:11:03 - Income eligibility).

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Medicaid for Recipients of SSI and Related Programs

Office of Medical Eligibility - Overview

South Dakota Department of Social Services (DSS)

Welcome and Introduction to the South Dakota Benefits Information System

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