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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 359MEDICARE SAVINGS PROGRAM
RULE §359.103Qualified 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

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