Rental income is generally countable income for MA eligibility. In this case, the petitioner’s SLMB+ benefits ended when his caregiver moved in and began paying $650/mo. towards his mortgage payment. Although the petitioner claimed the payment was made directly to a bank account he had no control over (a claim he failed to verify), ALJ Jason Grace concluded the agency correctly considered the $650 as income.
This decision was published with support from the Wisconsin chapter of the National Academy of Elder Law Attorneys and Krause Financial.
Preliminary Recitals
Pursuant to a petition filed on June 23, 2025, under Wis. Stat. § 49.45(5), and Wis. Admin. Code § HA 3.03(1), to review a decision by the La Crosse County Department of Human Services regarding Medical Assistance (MA), a hearing was held on July 29, 2025, by telephone. Hearings scheduled for July 16, 2025 and July 22, 2025, were rescheduled at the request or with the consent of the petitioner.
The issue for determination is whether the agency correctly found the petitioner exceeded income limits for the Medicare Saving Program.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: La Crosse County Department of Human Services
300 N. 4th Street
PO Box 4002
La Crosse, WI 54601
ADMINISTRATIVE LAW JUDGE:
Jason M. Grace
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) is a resident of Jackson County.
- The Petitioner was enrolled in SLMB+, a Medicare Savings Program.
- On March 21, 2025, the respondent contacted the agency and reported that his caregiver had moved into his residence that he owns and was paying him rent and utilities.
- On March 24, 2025, the agency issued notice to petitioner requesting proof that he owned his residence, the amount of his monthly mortgage and utility payments, and the amount of rent his caregiver was paying him.
- Petitioner provided the agency proof of home ownership and that his monthly mortgage payment (principal, interest, taxes, and insurance) was $1,588.32.
- On April 11, 2025, the petitioner and his caregiver contacted the agency and reported that the caregiver pays petitioner $650/month for shelter costs.
- On April 14, 2025, notice was issued to the petitioner indicating that his enrollment in SLMB+ was ending May 1, 2025, as income exceeded program limits.
- The agency found that petitioner had total monthly household income of $1,857, consisting of social security of $1,207.00 and rental payment of $650.00. He had total counted income of $1,837.00. The income limit for SLMB+ is $1,760.63.
- The petitioner filed an appeal.
Discussion
Medicare is a health insurance program administered by the federal Centers for Medicare & Medicaid Services (CMS) for people age 65 and older and for certain younger people with disabilities. Medicare is divided into two primary types of health coverage. Hospital insurance (Part A) pays hospital bills and certain skilled nursing facility expenses. Medical insurance (Part B) pays doctors’ bills and certain other charges. Medicaid Eligibility Handbook (MEH), § 32.1.
At hearing, the petitioner and his caregiver confirmed that the caregiver paid a portion of the petitioner’s monthly mortgage payment. She paid $650/month toward his monthly mortgage payment of $1,588.32. Petitioner argued that this $650/month payment is not countable income because it was not paid directly to him. Instead, he reported that it was deposited directly into a bank account linked to his mortgage payment that he did not control. He claimed that he did not have the ability to control the money in the account. The record was held open for 2 weeks to provide the petitioner an opportunity to submit proof from the bank supporting his claim. Nothing was received from the petitioner as of issuance of this decision. I agree with the agency that the $650 monthly payment is countable income to the petitioner for purposes of MA and the MSP. See MEH, §§ 15.1, 15.4, 15.5, and 15.6; also see MEH, § 15.3 (exempt and disregarded income).
Each MSP has different income eligibility requirements. The QMB income limit is 100% of the federal poverty level (FPL) (i.e., $1,304.17 per month in 2025 for a one-person assistance group). MEH § 32.2.3 and App. 39.5. The SLMB income limit is 120% FPL (i.e., $1,565.00 per month in 2025). MEH § 32.3.2 and App. 39.5. And, the SLMB + income limit is 135% FPL (i.e., 1,760.63 per month in 2025). MEH § 32.4.2 and App. 39.5. The agency must determine the total countable income and then subtract a $20 standard deduction. MEH §§32.1.2, 32.2.3, 32.3.2, 34.4.2.
Petitioner’s countable income of $1,837 exceeds the program limits for QMB, SLMB, and SLMB+ . He further does not qualify for QDWI as he is enrolled in Community Waivers. MEH, § 32.5.1. Thus, the agency correctly found that he was not eligible for the MSP.
Conclusions of Law
The agency correctly found the petitioner exceeded income limits for QMB, SLMB, and SLMB+.
THEREFORE, it is
Ordered
That petitioner’s appeal is dismissed.
[Request for a rehearing and appeal to court instructions omitted.]
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