Q-3100  SLMB Benefits

For SLMB-eligible persons, Medicaid pays only Medicare Part B premiums. However, enrollment in Medicare Part B is not an eligibility criterion.

Q-3200  SLMB Income Limits

For calendar years 1993 and 1994, the income limit is 110 percent of the federal poverty level. Beginning in 1995, the income limit is 120 percent of the federal poverty level.

The monthly income limits for certification are:

Note: These amounts do not include the $20 disregard. There must be at least a 1 cent unmet need for SLMB (MC-SLMB) eligibility.

SLMB uses the same resource limits as QMB (see Section Q-2500, QMB Income and Resource Limits). See Appendix XXXI, Budget Reference Chart.

Q-3300  SLMB Cost-of-Living Adjustment

For SLMB eligibility, the cost-of-living adjustment (COLA) in Social Security benefits is currently excluded for the months of January and February. To determine eligibility for applications and redeterminations, use the pre-COLA benefit amount during those months.

This income exclusion applies only to eligibility for QMB, SLMB, and QI. For QMB, SLMB and the QI eligibility, the RSDI Title II COLA is excluded during a “transition month” until the publication of the federal poverty level (FPL). Based on federal law codified in 42 U.S.C. 1396d(p)(2)(D)(ii), “transition month” means each month in a year through the month following the month in which the annual revision of the FPL is published. If the federal publication of the FPL is available in March, the transition months would include January, February and March. If the federal publication of the FPL is available in February, the transition months would include January and February.

For years after 1998 through 2007, the exclusion of the Social Security COLA for January through March applies. Beginning in 2008, the exclusion of the Social Security COLA for January through February applies.

Reference: See Chapter E, General Income, for deeming of income.

Q-3400 SLMB Medical Effective Date

A person's SLMB eligibility may begin with the month of application. A person with SLMB coverage is eligible for three months prior medical coverage, if all criteria are met.

Q-3500  SLMB Eligibility and Other Programs

When a Specified Low-Income Medicare Beneficiary (MC-SLMB) recipient becomes eligible for Supplementary Security Income (SSI), the MC-SLMB EDG in TIERS is automatically denied since SLMB is not allowed with SSI.

ME – Pickle, ME – SSI Prior, ME – Disabled Adult Child, and ME – A and D – Emergency cannot be dually eligible for SLMB. Even though ME – Pickle and ME – Disabled Adult Child may meet SLMB eligibility requirements, the Medicare Part B premium is already paid

Notes:

• ME – Early Aged Widow(er) and Disabled Widow(er) cannot be entitled to Medicare; therefore, not eligible for any MSP Program.
• A person is not eligible for SLMB coverage if the person is:
  • in the custody of penal authorities; or
  • over 20 years of age and under 65 years of age and resides in an institution for mental diseases (IMD).
• Persons age 65 or older residing in an IMD may be certified for SLMB, if all eligibility criteria are met. Persons of any age residing in state supported living centers may be certified for SLMB, if all eligibility criteria are met. SLMB ongoing and prior coverage is available for ICF/ID and state supported living center residents.
• SLMB ongoing and prior coverage is allowed with ME – Nursing Facility, which includes individuals on Mason Manor.
• SLMB ongoing and prior coverage is allowed with ME – Waivers.