Ill. Admin. Code tit. 89 § 120.73

Current through Register Vol. 48, No. 50, December 13, 2024

Section 120.73 - Eligibility for Payment of Medicare Part B Premiums for Specified Low-Income Medicare Beneficiaries (SLIBs) and Qualified Individiduals-1 (QI-1)

a) To the extent permitted under federal law ( 42 USC 1396 a(a)(10)), eligibility for payment of Medicare Part B premiums exists for Specified Low-Income Medicare Beneficiaries (SLIBs) and Qualified Individuals-1 (QI-1).

b) A SLIB is an individual who:

1) is a beneficiary of Medicare Part A (i.e., Hospital Insurance);

2) meets the general non-financial factors of eligibility for the Medicaid Program (see Sections 120.310, 120.311, 120.319 and 120.325 );

3) has countable monthly income greater than 100 percent of the Federal Poverty Level (FPL), but less than 120 percent of the FPL; and

4) has countable assets that do not exceed the QMB asset disregard (see Section 120.382(f)(1) ) .

c) A QI-1 is an individual who:

1) is a beneficiary of Medicare Part A (i.e., Hospital Insurance);

2) meets the general non-financial factors of eligibility for the Medicaid Program (see Sections 120.310, 120.311, 120.319 and 120.325);

3) has countable monthly income that is at least 120 percent of the FPL, but less than 135 percent of the FPL;

4) has countable assets that do not exceed the QMB asset disregard (see Section 120.382(f)(1) );

5) is not otherwise eligible for medical assistance; and

6) has been selected as a qualifying individual as provided under 42 USC 1396u-3.

d) In determining countable monthly income, the monthly amount of Social Security benefits to consider for January through the month following the month in which the annual FPL amounts are announced will not include the annual Retirement Survivors Disability Insurance (RSDI) Cost of Living Adjustment (COLA). For all other months of the year, the full amount of RSDI benefits will be considered.

e) Eligibility for payment of Medicare Part B premiums may be effective up to three months prior to the month of application.

f) Eligibility for SLIB status will be redetermined at least every 12 months.

Ill. Admin. Code tit. 89, § 120.73

Amended at 36 Ill. Reg. 4133, effective March 1, 2012