SECTION 359.103. Qualified Medicare Beneficiary Program

(a) Authorized under 42 U.S.C. §1396a(a)(10)(E)(i), the Qualified Medicare Beneficiary (QMB) Program pays Medicare premiums, deductibles, and coinsurance for a person who meets the requirements of this section. A person receiving Medicaid may also receive QMB benefits if the person meets the requirements of this section.

(b) To be eligible for QMB coverage, a person must:

(1) be entitled to benefits under Medicare Part A;

(2) meet income requirements in 42 U.S.C. §1396d(p), except for:

(A) payments made from or interest earned on a tuition savings program under 358.388 of this title (relating to Tuition Savings Programs);

(B) payments made from or interest earned on an Achieving a Better Life Experience (ABLE) account under §358.389 of this title (relating to Achieving a Better Life Experience Program); and

(C) income earned on a school-based savings program under §358.390 of this title (relating to School-Based Savings Program).

(3) meet resource requirements in 42 U.S.C. §1396d(p), except for:

(A) funds used to establish a tuition savings program under §358.356 of this title (relating to Tuition Savings Programs);

(B) funds used to establish an ABLE account and funds held in an ABLE account under §358.357 of this title (relating to Achieving a Better Life Experience Program); and

(C) funds held in a school-based savings program under §358.358 of this title (relating to School-Based Savings Program).

(c) A person is not eligible for QMB coverage if the person:

(1) is in the custody of penal authorities as defined in 42 C.F.R. §411.4(b); or

(2) is over 20 years of age and under 65 years of age and resides in an institution for mental diseases.

(d) A person's QMB eligibility begins on the first day of the month after the month the person is certified for QMB benefits.

(e) A person with QMB coverage is not eligible for three months prior medical coverage.

Source Note: The provisions of this §359.103 adopted to be effective September 1, 2009, 34 TexReg 5516; amended to be effective February 3, 2013, 38 TexReg 366; amended to be effective November 20, 2016, 41 TexReg 9004