To be non-financially eligible for Buy-In, an individual must be entitled to Medicare Part A and/or Part B. See section 488.2, Buy-In of Medicare Part A and section 488.3, Buy-In of Medicare Part B for entitlement information. To be financially eligible for Buy-In, an applicant or recipient of HCBS must meet the income and resource guidelines found in Appendix A.
By checking the 'Entitled to Medicare Part A?' box on the Individual Attributes screen in eCIS, the CAO will ensure that the system will review for Buy-In eligibility. The appropriate check box, 'Medicare Part A Recipient?' or 'Medicare Part B Recipient?' must be checked if the individual is a Medicare recipient.
NOTE: For married applicants or recipients of HCBS, the resources and income of the non-applicant/non-recipient spouse must be used to determine buy-in eligibility. The resources and income of the married couple are compared to the two-person Buy-In resource and income limits.
Eligibility for HCBS and eligibility for Buy-In are two distinct eligibility determinations. To be financially eligible for HCBS with Buy-In, an applicant or recipient of HCBS must meet the income and resource guidelines found in Appendix A for Buy-In, and have income within the Special NMP Income Limit found in 438 Appendix A, and meet the NMP resource limit found in 440 Appendix A.
NOTE: The CAO will use Healthy Horizons rules found in MAEH 319.7 when determining eligibility for QMB and SLMB Buy-In benefits.
The $20 unearned/earned income deduction and other Healthy Horizons deductions used to determine eligibility for Buy-In are not used to determine eligibility for payment of HCBS. The deductions are only used to determine eligibility for the Buy-In Program.
To be resource eligible for Buy-In, an applicant or recipient of HCBS must have total countable resources equal to or less than the Buy-In Program resource limits and the resource limits for HCBS. See Appendix A for the Buy-In resource limits.
Example One: Antonio is a single individual applying for payment of HCBS. He owns a checking account valued at $6,000.00 and a $900.00 savings account. Because the $6,900.00 value of Antonio’s total countable resources is less than the 2022 one-person Buy-In resource limit of $8,000.00 ($7,970.00 in 2021) and less than the HCBS resource limit of $2,000.00 (with a standard $6,000.00 disregard), Antonio is resource eligible for Buy-In and payment of HCBS.
Example Two: Brett is a married individual applying for payment of HCBS. He owns a checking account valued at $6,000.00 and a savings account valued at $900.00. His wife Bonnie owns a checking account valued at $3,000.00. Brett and Bonnie’s countable resources total $9,900.00. Because the couple’s total countable resources are less than the 2022 two-person Buy-In resource limit of $12,600.00 ($11,960.00 in 2021) and because Brett’s total countable resources of $6,900.00 are less than the HCBS resource limit of $2,000.00 (after the standard $6,000.00 disregard), Brett is resource eligible for Buy-In and payment of HCBS.
Example Three: Carter is a married individual applying for payment of HCBS. He owns a checking account valued at $8,500.00. His wife Cora owns a savings account valued at $1,000.00. Carter and Cora’s countable resources total $9,500.00. Although the couple’s total countable resources are less than the 2022 two-person Buy-In resource limit of $12,600.00; Carter is not eligible for Buy-in or payment of HCBS because his total countable resources exceed $2,000.00 (after the standard $6,000.00 disregard). Carter must reduce resources before being determined resource eligible for payment of HCBS.
NOTE: In 2022 the buy-in limit for one-person increased above the HCBS resource limit of $2,000.00 with a standard $6,000.00 disregard. Since a HCBS applicant or recipient cannot have countable resources exceeding $8,000.00 and be eligible for HCBS, the buy-in resource limit for HCBS applicants/recipients is $8,000.00.
To be income eligible for Buy-In, an applicant or recipient of HCBS must be within the Buy-In Program income limits. See Appendix A for the Buy-In income limits. When determining eligibility for Buy-In the Healthy Horizons unearned and earned income deductions found in MAEH 319.7 apply to the Buy-In determination. Net income after these allowable deductions must be within the Buy-In income limits listed in Appendix A.
An individual applying for or receiving payment of HCBS may be eligible for Buy-In as either a QMB or a SLMB:
QMB: In order to be eligible as a QMB, gross monthly income (after allowable Buy-In income deductions found in MAEH 319.7 ) must be equal to or less than 100% of the Federal Poverty Income Guidelines (FPIGs) found in Appendix A.
Example One: Andrew is a 70-year-old single individual applying for payment of HCBS. He receives RSDI income of $690.00 and a pension of $230.00 for a total gross monthly income of $920.00.
Gross Income: $920.00
Income Deduction: - $20.00
Net Income: $900.00
The $900.00 net income is less than the $1,133.00 Buy-In income limit in 2022 for one-person, ($1,074.00 in 2021 ) so Andrew is income eligible for payment of HCBS as a QMB in category PAW 80.
Example Two: Brandy is a 59-year-old married individual applying for payment of HCBS. She receives RSDI income of $336.00. Her husband Bernard receives RSDI income of $900.00. The total gross monthly income is $1,236.00.
Gross Income: $1,236.00
Income Deduction: - $20.00
Net Income: $1,216.00
The $1,216.00 net income is less than the $1,526.00 two-person Buy-In income limit for 2022 ($1,452.00 in 2021) so Brandy is income eligible for payment of HCBS as a QMB category PJW 80.
Example Three: Carter is a 68-year-old single individual applying for payment of HCBS. Carter receives RSDI income of $1,100.00 per month. Carter spends $20.00 per month on transportation to retrieve income from the bank and $15.00 per month in bank fees.
Gross
Income: $1,100.00
Transportation & bank fees: -$35.00
Income Deduction: -$20.00
Net Income: $1,045.00
The $1,045.00 net income is less than the $1,133.00 one-person Buy-In income limit for 2022 ($1,074.00 in 2021), so Carter is income eligible for a Buy-In category. Since Carter's gross income of $1,100.00 is less than the $2,523.00 Special NMP Income Limit for 2022 ($2,382.00 in 2021) Carter is eligible for payment of HCBS as a SLMB in category PAW 66.
The CAO will use Healthy Horizons rules when determining eligibility for QMB and SLMB benefits.
NOTE: The $20.00 unearned/earned income deduction is limited to $20.00 per budget group.
SLMB: In order to be eligible as a SLMB, gross monthly income (after allowable Buy-In income deductions found in MAEH 319.7 ) must be more than 100% but less than 120% of the FPIGs found in Appendix A.
Example One: Chase is a 50-year-old single individual applying for payment of HCBS. He receives RSDI income of $899.90 and a pension of $295.00 for a total gross monthly income of $1,194.90.
Gross Income: $1,194.90
Income Deduction: - $20.00
Net Income: $1,174.90
The $1,174.90 net income is less than the $1,358.99 one-person Buy-In income limit for 2022 ($1,287.99 in 2021), so Chase is income eligible for payment of HCBS as a SLMB in category PJW 66.
Example Two: Dorothy is a 70-year-old married individual applying for payment of HCBS. She receives RSDI income of $600. Her husband Drew receives RSDI income of $1,080.00. The total gross monthly income is $1,680.00.
Gross Income: $1,680.00
Income Deduction: - $20.00
Net Income: $1,660.00
The $1,660.00 net income is less than the $1,830.99 two-person Buy-In income limit for 2022 ($1,741.99 in 2021) so Dorothy is income eligible for payment of HCBS as a SLMB in category PAW 66.
Example Three: Chris is a 71-year-old single individual applying for payment of HCBS. Chris receives RSDI income of $1,320.00 per month. Chris spends $20.00 per month on transportation to retrieve his income from the bank and $15.00 per month in bank fees.
Gross
Income: $1,320.00
Transportation & bank fees: -$35.00
Income Deduction: -$20.00
Net Income: $1,265.00
The $1,265.00 net income is less than the $1,358.99 one-person Buy-In income limit for 2022 ($1,287.99 in 2021), so Chris is income eligible for a Buy-In category. Since Chris's gross income of $1,320.00 is less than the $2,523.00 Special NMP Income Limit for 2022 ($2,382.00 in 2021) Chris is eligible for payment of HCBS as a SLMB in category PAW 66.
The CAO will use Healthy Horizons rules when determining eligibility for QMB and SLMB benefits
NOTE: The $20.00 unearned/earned income deduction is limited to $20.00 per budget group.
If the individual is not entitled to Medicare and/or the individual is not financially eligible for Buy-In then eligibility for payment of HCBS without Buy-In must be determined. When determining eligibility for payment of HCBS without Buy-In, only the income before deductions of the individual applying for HCBS is used. The income of the individual applying for or receiving payment of HCBS must be equal to or less than the NMP Special Income Limit which is 300% of the Federal Benefit Rate (FBR), currently $2,523.00 in 2022, found in Chapter 468 Appendix A.
NOTE: The $20 unearned/earned income deduction and other Healthy Horizons deductions used to determine eligibility for Buy-In are not used to determine eligibility for payment of HCBS. The deductions are only used to determine eligibility for the Buy-In Program.
Example One: Ezekiel is a 70-year-old single individual applying for payment of HCBS. He receives RSDI income of $1,600.00 and a pension of $1000.00 for a total gross monthly income of $2,600.00.
Gross Income: $2,600.00
The $2,600.00 gross income is greater than the NMP Special Income limit, currently $2,523.00 in 2022 ($2,382.00 in 2021) so Ezekiel is not eligible for payment of HCBS.
Example Two: Felicia is a 55-year-old married individual applying for payment of HCBS. She receives RSDI income of $900.00. Her husband Fred receives Railroad Retirement Benefits of $1,900.00. The total gross monthly income of Felicia is $900 but because the net income of the married couple exceeds the two-person Buy-In income limits, Felicia is reviewed for income eligibility without Buy-In. Felicia has income below the NMP Special Income Limit, currently $2,523.00 in 2022, ( $2,382.00 in 2021) so Felicia is income eligible in a PJW 00 category.
Gross Income of the Married Couple: $2,800.00
Income Deduction: -$20.00
Net Income: $2,780.00
The $2,780.00 net income is greater than the $1,830.99 two-person Buy-In income limit in 2022 ($1,741.99 in 2021), so eligibility for payment of HCBS without Buy-In must be determined. Felicia’s $900.00 gross income is below the NMP Special Income Limit, currently $2,523.00 in 2022 ($2,382.00 in 2021) so Felicia is income eligible for payment of HCBS in category PJW 00.
Updated June 15, 2022, Replacing February 3, 2022