WAC 182-517-0310

Effective July 1, 2012

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.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.