Library: Policy

317:35-17-1. Overview of long-term medical care services; relationship to Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), and other Medicaid (SoonerCare) services eligibility

Revised 9-1-24

Rule text available at Oklahoma Health Care Authority website.

317:35-17-1(b)  • 1

INSTRUCTIONS TO STAFF 317:35-17-1

Issued 12-15-20

1.  When a married applicant applies for ADvantage waiver services and is determined financially and medically eligible for the program, the worker separates the couple's income and resources to make a Qualified Medicare Beneficiary Plus (QMBP) and Specified Low Income Medicare Beneficiary (SLMB) determination for each person based on the individual income and resource standards, per Oklahoma Human Services (OKDHS) Appendix C-1, Maximum Income, Resource, and Payment Standards, Schedule VI and VII, instead of the couple standard.  The worker codes each person as "Married But Involuntarily Separated (MP)" in the "marital status" field of the Household tab in the Family Assistance/Client Services Interview Notebook.  The worker does not separate the couple's income and resources to determine their eligibility for State Supplemental Payment or State Plan Personal Care.

(1) Example:  A wife receives $900 Retirement, Survivors, and Disability Insurance (RSDI) benefits and her husband receives $1,100 RSDI benefits.  They are not eligible for QMBP or SLMB based on the income and resource standards for couples, per OKDHS Appendix C-1, Schedule VI and VII.  The wife applies for ADvantage waiver services and is determined financially and medically eligible for the program.  The couple's income and resources can now be separated to determine their individual eligibility for QMBP and SLMB.  The worker codes each person as MP in the "marital status" field.  In this example, the wife is now eligible for the Medicare Part B premium payment (Buy-In) under QMBP using the individual income standard, per OKDHS Appendix C-1, Schedule VI.  Her ADvantage waiver approval covers Medicaid services.  The husband does not qualify for QMBP, but does qualify for SLMB using the individual income standard, per OKDHS Appendix C-1, Schedule VII, if he is approved for Medicare.  The worker uses the individual resource standard to determine resource eligibility for each person.

(2) Example:  A wife receives $1,500 RSDI benefits and her husband receives $900 RSDI benefits.  They are not eligible for QMBP or SLMB based on the income and resource standards for couples, per OKDHS Appendix C-1, Schedule VI and VII.  The wife applies for ADvantage waiver services and is determined financially and medically eligible for the program.  The couple's income and resources can now be separated to determine their individual eligibility for QMBP and SLMB.  The worker codes each person as MP in the "marital status" field.  The wife does not qualify for the Medicare Part B premium payment (Buy-In) under QMBP or SLMB based on the individual income standard, per OKDHS Appendix C-1, Schedule VI and VII.  Her Advantage waiver approval covers Medicaid services.  The husband qualifies for QMBP based on the individual income standard, per OKDHS Appendix C-1, Schedule VI.  The worker uses the individual resource standard to determine resource eligibility for each person.