WAC 182-517-0310 Eligibility for federal Medicare savings and state-funded Medicare buy-in programs

1. Persons eligible for any medicare savings programs (MSP) must: 

   1. Be entitled to or receiving medicare Part A. Qualified disabled working individuals (QDWI) clients must be under age sixty-five;

   2. Meet program income standards, see WAC 388-478-0085; and

   3. Have resources equal to or less than the medicare Part D low-income subsidy resource standard found at:  http://hrsa.dshs.wa.gov/Eligibility/PDF/StandardsChart909.pdf. MSP follow SSI categorically needy program rules for SSI related persons in chapter 388-475 WAC.

2. MSP clients are entitled to a fair hearing when the department takes an adverse action such as denying or terminating MSP benefits.

3. The department subtracts the allocations and deductions described under WAC 388-513-1380  from a long-term care client’s countable income and resources when determining MSP eligibility;

   1. Allocations to a spouse and/or dependent family member; and

   2. Client participation in cost of care.

4. Medicaid eligibility may affect MSP eligibility, as follows:

   1. Qualified medicare beneficiaries (QMB) and specified low income beneficiaries (SLMB) clients can receive medicaid and still be eligible to receive QMB or SLMB benefits.

   2. Qualified individuals (QI-1) and qualified disabled working individuals (QDWI) clients who begin to receive medicaid are no longer eligible for QI-1 or QDWI benefits.

5. Every year, when the federal poverty level changes;

   1. The department adjusts income standards for MSP and state funded medicare buy-in programs, see WAC 388-478-0085.

   2. The department begins to count the annual Social Security cost-of-living (COLA) increase on April 1st each year when determining eligibility for MSP and state funded medicaid buy-in programs.

6. There is no income limit for the state-funded medicare buy-in program. The state funded medicare buy-in program is for clients who receive medicaid but do not qualify for the federal MSP.