OKDHS - OAC 317:35-7-40 Eligibility as Qualified Medicare Beneficiary Plus

317:35-7-40. Eligibility as Qualified Medicare Beneficiary Plus

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Revised 05-11-01

(a) An individual determined to be categorically related to aged, blind or disabled is eligible for Medical Services as a Qualified Medicare Beneficiary Plus (QMBP) if he/she meets the conditions of eligibility shown in paragraphs (1)-(3) of this subsection. For persons age 65 and older in mental health hospitals, refer to OAC 317:35-9-7.

(1) The individual's/couple's income and resources do not exceed the standards as shown on DHS Appendix C-1, Schedule VI, of which the income standard is based on 100% of the Federal Poverty Level. •1
(2) Countable income and resources are determined using the same rules followed in determining eligibility for individuals categorically related to Aid to the Aged, Blind or Disabled, except that a $20 general income disregard is applied to either earned or unearned income, but not both. For couples, only one $20 general income disregard is given.
(3) The individual meets all other eligibility conditions for Medicaid.

(b) Medical identification cards are issued to all individuals determined eligible for QMBP coverage. •2

INSTRUCTIONS TO STAFF 317:35-7-40

Individuals who are entitled to Part A coverage upon the buy-in being completed are considered to be Conditional Part A Enrollees. An individual who is enrolled in Medicare Part B and meets all eligibility requirements for QMB except enrollment in Part A is eligible for Part A upon the buy-in being completed. In these instances the case is certified as QMB eligible and the buy-in is automatically completed for the Part A enrollment effective the date of certification.
Individual determined as dually eligible for Title XIX medical services as categorically needy or medically needy and for QMB coverage must be coded and both "M" benefit (for Medical) and "Q" benefit (for QMB). For individuals eligible as categorically needy and receiving a State Supplemental payment who are also determined eligible for QMB coverage, and additional update is not required to indicate QMB eligibility.

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