CHAPTER 67:46:11
\r\n\r\n\r\nQUALIFIED MEDICARE\r\nBENEFICIARIES (QMB)
\r\n\r\n\r\n\r\nSection
\r\n\r\n67:46:11:01 Definitions.
\r\n\r\n67:46:11:02 Long-term care requirements applicable to\r\nQI, QMB and SLMB.
\r\n\r\n67:46:11:03 Income eligibility.
\r\n\r\n67:46:11:04 Repealed.
\r\n\r\n67:46:11:05 Deduction for court-ordered support or\r\nsupport enforced by OCSE.
\r\n\r\n67:46:11:06 Items not considered income when\r\ndetermining QI, QMB or SLMB eligibility.
\r\n\r\n67:46:11:07 Income from self-employment.
\r\n\r\n67:46:11:08 Deduction from earned income.
\r\n\r\n67:46:11:09 Income disregard.
\r\n\r\n67:46:11:10 Repealed.
\r\n\r\n67:46:11:11 Disposal of resources.
\r\n\r\n67:46:11:12 Date of eligibility.
\r\n\r\n67:46:11:13 Payment limits.
\r\n\r\n\r\n\r\n67:46:11:01. Definitions. Terms\r\ndefined in § 67:16:01:01 have the same meaning when used in this chapter.\r\nIn addition, terms used in this chapter mean:
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(1) "BIA," the bureau of\r\nIndian affairs;
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(2) "Coinsurance," that\r\nportion of the medical costs allowable but not payable by Medicare and for\r\nwhich the individual is responsible;
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(3) "Deductible," the initial\r\namount of allowable Medicare costs paid by the individual before Medicare\r\nbegins paying;
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(4) "Medicare," the federal\r\nhealth insurance program available through the social security administration\r\nfor certain disabled individuals and for individuals 65 years of age or older;
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(5) "OCSE," the office of\r\nchild support enforcement within the department of social services;
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(6) "Part A," insurance\r\navailable through the Medicare program to help pay for medically necessary\r\nhospice or home health care or care in a hospital or skilled nursing facility;
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(7) "Part B," insurance\r\navailable through the Medicare program to help pay for medically necessary\r\nphysician services, outpatient hospital services, and medical supplies;
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(8) "Qualifying Individual"\r\nor "QI," a person who meets the requirements of this chapter and who\r\nis not otherwise eligible for Medicaid benefits and for whom the state pays the\r\nPart B Medicare premium;
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(9) "Qualified Medicare\r\nbeneficiary" or "QMB," a person who meets the requirements of\r\nthis chapter and for whom the state pays the Medicare Part A and Part B\r\npremiums, deductibles, coinsurance, and copayments;
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(10) "SCORE," the service\r\ncorps of retired executives;
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(11) "Special low-income Medicare\r\nbeneficiary" or "SLMB," a person who meets the requirements of\r\nthis chapter and for whom the state pays the Part B Medicare premium; and
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(12) "VISTA," the volunteers\r\nin service to America.
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Source: 15 SDR 171, effective May 15, 1989;\r\ntransferred from § 67:16:30:01, effective August 23, 1992; 19 SDR 141,\r\neffective March 25, 1993; 41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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67:46:11:02. Long-term care\r\nrequirements applicable to QI, QMB and SLMB. All provisions of chapters\r\n67:46:02 to 67:46:05, inclusive, and 67:46:08 apply to QI, QMB and SLMB\r\napplicants and recipients unless otherwise specified in this chapter.
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Source: 15 SDR 171, effective May 15, 1989;\r\ntransferred from § 67:16:30:02, effective August 23, 1992; 19 SDR 141,\r\neffective March 25, 1993; 41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
67:46:11:03. Income eligibility.\r\nAfter the $20 disregard, income for a QMB individual may not exceed 100 percent\r\nof the federal poverty level established in § 67:11:01:03. If the\r\nindividual's countable income is 100 percent of the federal poverty level or\r\nless and the individual is married and living with a spouse, the income of the\r\nspouse must be considered. If their combined countable income exceeds 100\r\npercent of the federal poverty level for two individuals, the individual is\r\nineligible.
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After the $20 disregard, the countable income for\r\na SLMB individual must exceed 100 percent of the federal poverty level and be\r\nless than 120 percent of the federal poverty level. If the individual's\r\ncountable income is less than 120 percent of the federal poverty level and the\r\nindividual is married and living with a spouse, the income of the spouse must\r\nbe considered. If their combined countable income is equal to or greater than\r\n120 percent of the federal poverty level for two individuals, the individual is\r\nineligible.
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After the $20 disregard, the countable income for\r\na QI individual must be at least 120 percent of the federal poverty level and\r\nbe less than 135 percent of the federal poverty level. If the individual's\r\ncountable income is less than 135 percent of the federal poverty level and the\r\nindividual is married and living with a spouse, the income of the spouse must\r\nbe considered. If their combined countable income is equal to or greater than\r\n135 percent of the federal poverty level for two individuals, the individual is\r\nineligible.
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Source: 15 SDR 171, effective May 15, 1989;\r\n16 SDR 203, effective May 27, 1990; transferred from § 67:16:30:03,\r\neffective August 23, 1992; 19 SDR 141, effective March 25, 1993; 20 SDR 92,\r\neffective December 21, 1993; 21 SDR 162, effective March 23, 1995; 41 SDR 93,\r\neffective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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Cross-Reference: Income disregard,\r\n§ 67:46:11:09.
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67:46:11:04. Deduction from income\r\nfor dependent child. Repealed.
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Source: 15 SDR 171, effective May 15, 1989;\r\n16 SDR 203, effective May 27, 1990; transferred from § 67:16:30:04,\r\neffective August 23, 1992; 19 SDR 141, effective March 25, 1993; 21 SDR 162,\r\neffective March 23, 1995; repealed, 41 SDR 93, effective December 3, 2014.
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67:46:11:05. Deduction for court-ordered support or support\r\nenforced by OCSE. The department shall deduct from the ineligible spouse's\r\nincome that portion of the income paid under court order or enforced by OCSE\r\nfor the support of another person who is not in the household.
\r\n\r\n\r\nSource:\r\n15 SDR 171, effective May 15, 1989; transferred from § 67:16:30:05,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
\r\n\r\n\r\n67:46:11:06. Items not considered\r\nincome when determining QI, QMB or SLMB eligibility. In addition to those\r\nitems contained in § 67:46:04:03, the following items are not considered\r\nincome when determining QI, QMB or SLMB eligibility:
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(1) Assistance based on need provided\r\nby a local government or nongovernmental agency, such as Catholic Charities,\r\ncounty assistance, or assistance from the Salvation Army;
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(2) Replacement of resources in cash or\r\nin kind because of loss, damage, or theft of property;
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(3) Home energy assistance;
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(4) Home produce for personal use;
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(5) Foster care payments made to a\r\nfoster care provider;
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(6) Grants or loans to undergraduate\r\nstudents for educational purposes which are insured by the United States\r\nsecretary of education;
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(7) Housing assistance from housing and\r\nurban development or farmer's home administration;
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(8) Credit life or credit disability\r\ninsurance payments on loans, installment purchases, and similar items in the\r\nevent of death or disability;
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(9) Money borrowed;
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(10) Money received as repayment on the\r\nprincipal of a loan;
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(11) Reimbursements for expenses of\r\nobtaining income such as per diem payments and mileage;
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(12) United States department of\r\nagriculture food commodities, the value of coupon allotments from government\r\nagencies and, for an individual age 60 or over, the value of meals received at\r\na center or the value of meals delivered to the individual's home;
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(13) Any benefits received under the\r\nprovisions of the Older Americans Act of 1965, except wages or salary;
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(14) Payments to volunteers under the\r\nDomestic Volunteer Service Act of 1973, such as from SCORE, VISTA, or the\r\nfoster grandparent program; and
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(15) Indian judgment funds distributed\r\non a per capita basis.
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Source: 15 SDR 171, effective May 15, 1989;\r\ntransferred from § 67:16:30:06, effective August 23, 1992; 19 SDR 141,\r\neffective March 25, 1993; 41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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67:46:11:07. Income from self-employment. The net income\r\nfrom self-employment is considered earned income. Net income is the taxable\r\nincome declared on the individual's most recent income tax return. If a tax\r\nreturn was not filed or was filed and indicated no self-employment, the net\r\nincome is as established on either a profit and loss statement or on some other\r\nbusiness record for the tax year.
\r\n\r\n\r\nSource:\r\n15 SDR 171, effective May 15, 1989; transferred from § 67:16:30:07,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
\r\n\r\n\r\n67:46:11:08. Deduction from earned income. A deduction of\r\n$65 plus one-half of the remainder is deducted from the total monthly earned\r\nincome. If the individual is living with a spouse, the earned income deduction\r\napplies to the couple's total earned income.
\r\n\r\n\r\nSource:\r\n15 SDR 171, effective May 15, 1989; transferred from § 67:16:30:08,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
\r\n\r\n\r\n67:46:11:09. Income disregard.\r\nThe department shall disregard $20 a month from the applicant's or recipient's\r\nunearned income unless the income is from a source based on need, such as\r\ncertain veterans' benefits, TANF, or BIA general assistance. If unearned income\r\nis less than $20, the difference shall be deducted from the applicant's or\r\nrecipient's gross earned income before applying the earned income disregard\r\nprovided in § 67:46:11:06. If\r\nthe individual is living with the individual's spouse, the $20 deduction\r\napplies to the couple's combined income.
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Source: 15 SDR 171, effective May 15, 1989;\r\ntransferred from § 67:16:30:09, effective August 23, 1992; 41 SDR 93,\r\neffective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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67:46:11:10. Resource\r\nlimit. Repealed
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Source:\r\n15 SDR 171, effective May 15, 1989; transferred from § 67:16:30:10,\r\neffective August 23, 1992; 19 SDR 141, effective March 25, 1993; 41 SDR 7,\r\neffective July 29, 2014; 41 SDR 93, effective December 3, 2014; 41 SDR 218,\r\neffective June 30, 2015; 44 SDR 94, effective December 4, 2017; 45 SDR 82,\r\neffective December 10, 2018.
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67:46:11:11. Disposal of resources. The value of resources disposed of and no longer owned by the\r\nindividual are not considered. The provisions of §§ 67:46:05:06 and\r\n67:46:05:07 do not apply.
\r\n\r\n\r\nSource:\r\n15 SDR 171, effective May 15, 1989; transferred from § 67:16:30:11,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
\r\n\r\n\r\n67:46:11:12. Date of eligibility.\r\nBenefits for individuals eligible for QMB begin with the month after the month\r\nin which the individual is determined eligible. Eligibility starting dates\r\noutlined in § 67:46:01:03 do not apply.
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Benefits for individuals eligible for SLMB or QI\r\nbegin with the first day of the month of application. Eligibility may begin as\r\nearly as the first day of the third month prior to the month of application if\r\nall eligibility criteria are met.
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Source: 15 SDR 171, effective May 15, 1989;\r\ntransferred from § 67:16:30:12, effective August 23, 1992; 19 SDR 141,\r\neffective March 25, 1993; 41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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67:46:11:13. Payment limits. If\r\nan individual is eligible for QMB, payment is limited to Medicare premiums,\r\ndeductibles, coinsurance, and copayment for Part A and Part B of Medicare.
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If an individual is eligible for SLMB, payment is\r\nlimited to the Part B Medicare premium.
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If an individual is eligible for QI, payment is\r\nlimited to the Part B Medicare premium. The department may discontinue services\r\nprovided under the provisions of this chapter if the department exhausts its\r\nfinancial resources for providing the services.
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Source: 15 SDR 171, effective May 15, 1989;\r\ntransferred from § 67:16:30:13, effective August 23, 1992; 19 SDR 141,\r\neffective March 25, 1993; 41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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