NOTICES
Notice of Rule Change--Increase in Income Limitations
[28 Pa.B. 3626] The Department of Public Welfare (Department) announces that effective January 1, 1998, it is implementing the income limitation changes mandated by Section 4732 of the Balanced Budget Act of 1997, Public Law 105-33, enacted August 5, 1997, which amended the Social Security Act at Section 1902(a)(10)(E) (42 U.S.C.A. § 1396a (a)(10)(E)). These changes are implemented in conjunction with existing policy and expand the income limitations for individuals who can apply for full or partial payment of the Medicare Part B premium. Individuals who will qualify for full payment of the Medicare Part B premium are identified as Qualifying Individuals--1 (QI-1s). Individuals who will qualify for a partial payment are identified as QI-2s. This Rule Change will be adopted by final rulemaking omitting proposed to the 55 Pa. Code Chapter 140, Special MA Eligibility Provisions.
These changes affect those individuals who are elderly and/or disabled and are applying for Medical Assistance (MA) under the Healthy Horizons Categorically Needy eligibility requirements. The Department's existing policy provides for Medicare cost-sharing and/or payment of Medicare Part B premiums. Individuals with family income up to 100% of the current Federal Poverty Income Guideline (FPIG) and resources not exceeding twice the aged, blind or disabled (Supplemental Security Income (SSI)-related) resource standard for the appropriate family size qualify for payment of full Medicare deductibles and coinsurance and payment of Medicare Part B premiums. These individuals are identified as Qualified Medicare Beneficiaries (QMBs). Individuals with family income up to 100% of the current FPIG and resources not exceeding $2,400 for an individual and $3,200 for a couple qualify for payment of coinsurance and/or deductibles up to the Medicaid rate and payment of Medicare Part B premiums. These individuals are identified as Specified Low-Income Beneficiaries (SLMBs). Individuals with family income which is more than 100% of the FPIG but does not exceed 120% of the current FPIG and resources not exceeding twice the SSI-related resource standard for the appropriate family size only qualify for payment of Medicare Part B premiums. These individuals are identified as SLMBs.
Individuals with income up to 120% but not exceeding 135% of the current FPIG can qualify for payment of the Medicare Part B premium. This group will be identified as QI-1s. Individuals whose income is at least 135% of the FPIG but not exceeding 175% of the current FPIG and resources not exceeding twice the SSI-related resource standard for the appropriate family size can qualify for partial payment of the Medicare Part B premium. This group will be identified as QI-2s.
The Department is required to implement the mandatory provisions of the Balanced Budget Act of 1997. If the Department does not implement these requirements, the Department risks Federal financial sanctions.
This Rule Change has been reviewed and approved by the Office of General Counsel and the Office of Attorney General.
This Rule Change is made under the Joint Committee on Documents Resolution 1998-1(2), 28 Pa.B. 2629 (June 6, 1998), and will be in effect for 365 days pending adoption of final rulemaking by the Department.
Public comments to this Rule Change may be made for 30 days from the date of publication in the Pennsylvania Bulletin by writing to Edward J. Zogby, Acting Director, Bureau of Policy, Office of Income Maintenance, Room 431, Health and Welfare Building, Harrisburg, PA 17120.
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FEATHER O. HOUSTOUN,
SecretaryPurpose
To advise County Assistance Offices (CAOs) of changes in the income limitations for those persons who are elderly and/or disabled and applying for, or receiving, Medical Assistance (MA) as either Qualified Medicare Beneficiaries (QMBs) or Specified Low-Income Medicare Beneficiaries (SLMBs) and whose income does not exceed the increased amounts as specified in the Balanced Budget Act of 1997, Public Law 105-33, enacted August 5, 1997.
Background
The Department's existing policy provides for Medicare cost-sharing and/or payment of Medicare Part B premiums. Individuals with family income up to 100% of the current Federal Poverty Income Guidelines (FPIG) and resources not exceeding twice the aged, blind or disabled (Supplemental Security Income (SSI-related) resource standard for the appropriate family size qualify for payment of full Medicare deductibles and coinsurance and payment of Medicare Part B premiums. These individuals are identified as Qualified Medicare Beneficiaries (QMBs). Individuals with family income up to 100% of the current FPIG and resources not exceeding $2,400 for an individual and $3,200 for a couple qualify for payment of coinsurance and/or deductibles up to the Medicaid rate and payment of Medicare Part B premiums. These individuals are identified as Specified Low-Income Medicare Beneficiaries (SLMBs). Individuals with family income which is more than 100% of the FPIG but does not exceed 120% of the current FPIG and resources not exceeding twice the SSI-related resource standard for the appropriate family size only qualify for payment of Medicare Part B premiums. These individuals are also identified as SLMBs.
Discussion
The Balanced Budget Act of 1997 mandates that there is an expansion in income limitations to qualify for payment of the Medicare Part B premium. Individuals with income up to 120% but not exceeding 135% of the current FPIG can qualify for payment of the Medicare Part B premium. This group will be identified as a Qualifying Individual--1 Group (QI-1). Additionally, the Balanced Budget Act of 1997 provides for a partial payment of Part B Premiums for those individuals whose income is at least 135% of the FPIG but not exceeding 175% of the current FPIG and resources not exceeding twice the SSI-related resource standard for the appropriate family size. This group will be identified as Qualifying Individuals--2 Group (QI-2).
These changes affect those individuals who are elderly and/or disabled and applying for Medical Assistance under the Healthy Horizons Categorically Needy eligibility requirements.
Fiscal Note: 14-NRC-74. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 98-1239. Filed for public inspection July 31, 1998, 9:00 a.m.]
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