612 How to Calculate Income Eligibility for Medicare Savings Program (MSP)

100% of the Federal Poverty Level (FPL).

Greater than 100% but equal to or less than 120% of the FPL.

Greater than 120% but equal to or less than 135% of the FPL.

Varies

Varies

$20.00

$65.00

Varies

Varies

Varies

Varies

The net unearned income is calculated as follows:

• The counted unearned income of the customer is totaled;

• If a customer child receives child support payments, 1/3 of the child support payment is subtracted;

• The $20.00 general income deduction is subtracted; and

• Needs based assistance payments are added.

The net earned income is calculated as follows:

• The counted earned income of the customer is totaled;

• The Student Earned Income Exclusion (only if under age 22) is subtracted;

• The unused portion of the $20.00 deduction is subtracted;

• The $65.00 work expense deduction is subtracted;

• Impairment Related Work Expenses are subtracted;

• ½ subtotal of earned income are subtracted; and

• Blind Work Expenses are subtracted.

NOTE     If any of the remaining subtractions listed in this step result in a $0.00 subtotal or negative subtotal, the net earned income amount is $0.00.

The total net income is calculated as follows:

• The subtotal obtained from Step 1 is added to subtotal obtained in Step 2; and

• Child Allocations are subtracted.

The result is compared to the QMB, SLMB, and QI-1 income standards for an individual. If the income is:

• Less than or equal to 100% of the FPL, the customer qualifies for QMB.

• Greater than 100% but less than or equal to 120% of FPL, the customer qualifies for SLMB.

• Greater than 120% but less than or equal to 135% of FPL, the customer qualifies for QI-1.

The total gross unearned income is calculated as follows:

• The counted unearned income of the customer and spouse is totaled;

• If a customer child receives child support payments, 1/3 of the child support payment is subtracted;

• The $20.00 general income deduction is subtracted; and

• Needs based assistance payments are added.

The net earned income is calculated as follows:

• The Student Earned Income Exclusion is subtracted from customer’s counted earned income (only if under age 22);

• The Student Earned Income Exclusion is subtracted from spouse’s counted earned income (only if under age 22);

• After the Student Earned Income Exclusion has been subtracted, the counted earned income of the customer and spouse is subtotaled;

NOTE     If any of the remaining subtractions listed in this step result in a $0.00 subtotal or negative subtotal, the net earned income amount is $0.00.

The following are subtracted from the subtotal in this order:

• The unused portion of the $20.00 deduction;

• $65.00 work expense deduction;

• Impairment Related Work Expenses;

• ½ subtotal of earned income; and

• Blind Work Expenses.

The total net income is calculated as follows:

• The subtotal obtained from Step 1 is added to the subtotal obtained in Step 2; and

• Child Allocations are subtracted.

The result is compared to the QMB, SLMB, and QI-1 income standards for a couple. If the income is:

• Less than or equal to 100% of the FPL, the customer qualifies for QMB.

• Greater than 100% but less than or equal to 120% of FPL, the customer qualifies for SLMB.

• Greater than 120% but less than or equal to 135% of FPL, the customer qualifies for QI-1.

Action

Calculate a child allocation amount for each ineligible parent’s children living in the home (see MA609B.8 for calculation steps).

Combine all of the child allocation amounts to get the total Child Allocation.

Action

Total the gross counted unearned income of the ineligible parents and subtract the total Child Allocation from Step 2.

• If the result is a negative number, this is the remaining unused Child Allocation. There is no remaining unearned income.

• If the result is a positive number, this is the remaining unearned income. There is no unused Child Allocation.

• If the result is exactly zero, there is no unused Child Allocation and no remaining unearned income.

For each ineligible parent under age 22 that meets the definition of a student, subtract the Student Earned Income Exclusion (MA609.B.2).

Total the earned income of the ineligible parents from Step 4 and subtract any unused Child Allocation from Step 3.

• If the result is zero or a negative number there is no remaining earned income.

• If the result is a positive number, this is the remaining earned income.

Determine if there is any remaining unearned income or remaining earned income to be deemed.

• If there is no remaining income from Step 3 or Step 5, the amount of income deemed from the ineligible parents is $0.00. Skip to step 10

• If there is remaining unearned or earned income from Step 3 or Step 5, continue to Step 6

Subtract the $20.00 general income deduction from any remaining unearned income to get the net unearned income.

Subtract the following deductions in order from any remaining earned income to get the net earned income:

• Any unused portion of the $20.00 deduction;

• The $65.00 work expense deduction;

• Any Impairment Related Work Expenses;

• ½ subtotal of earned income; and

• Any Blind Work Expenses.

Add the net unearned income from Step 6 to the net earned income from Step 7 to get the total net income.

To get the total deemed income amount, take the total net income from Step 8 and subtract:

• The individual 100% FPL amount if the customer has only one ineligible parent; or

• The couple 100% FPL if the customer has two ineligible parents.

Action

To calculate the net unearned income:

• Add the deemed income amount to the customer child’s counted unearned income except for needs based payments;

• If a customer child receives child support payments, subtract 1/3 of the child support payment;

• Subtract the $20.00 general income deduction; and

• Add in any needs based payments.

To calculate the net earned income:

• Total the counted earned income of the customer child;

• Subtract any student earned income exclusion;

• Subtract and unused portion of the $20.00 general deduction;

• Subtract the $65.00 work expense deduction;

• Subtract any Impairment Related Work Expenses;

• Subtract ½ of remaining earned income; and

• Subtract any Blind Work Expenses.

Add the net unearned income from Step 10 to the net earned income from Step 11 to get the total net income.

Calculate a child allocation amount for each customer child’s children living in the home (see MA609.B.8 for calculation steps) and subtract the total child allocations from the total net income from Step 12

The result is compared to the QMB, SLMB, and QI-1 income standards for an individual. If the income is:

• Less than or equal to 100% of the FPL, the customer qualifies for QMB.

• Greater than 100% but less than or equal to 120% of FPL, the customer qualifies for SLMB.

• Greater than 120% but less than or equal to 135% of FPL, the customer qualifies for QI-1.

Means a person who:

• Is not married (including divorced); and

• Is under age 18; or

• For child allocation deductions only, is under age 22 and is a student regularly attending a school, college or university, or a course of vocational or technical training to prepare for gainful employment.

A natural or adoptive parent, or stepparent who is NOT receiving SSI-Cash benefits, ALTCS, Freedom to Work, MSP or SSI-MAO.

42 USC 1396a(a)(10)(E)

AAC R9-29-212 and 213