Texas Health and Human Services Commission
Medicaid for the Elderly and People with Disabilities Handbook
Revision: 13-3
Effective: September 1, 2013

Q-3000

Specified Low-Income Medicare Beneficiaries (SLMB) – MC-SLMB

The Specified Low-Income Medicare Beneficiary (SLMB) program is an extension of QMB.

Authorized under 42 U.S.C. §1396a(a)(10)(E)(iii), the SLMB Program pays only Medicare Part B premiums for a person who meets the requirements for SLMB. A person receiving Medicaid may also receive SLMB benefits.

To be eligible for SLMB coverage, a person must meet the eligibility criteria for QMB coverage (see Section Q-2000, Qualified Medicare Beneficiaries (QMB) – MC-QMB, except the person must have an income that is greater than 100% but less than 120% of the federal poverty level.

A person is not eligible for SLMB coverage if the person is:

Note: 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.

Q-3100  SLMB Benefits

Revision 09-4; Effective December 1, 2009

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

Revision 13-2; Effective June 1, 2013

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:

Time Period
Range/Limit
for Persons
Range/Limit
for Couple
Deeming
March 1, 2013 to present
$958.01 to $1,149
$1,293.01 to $1,551
$402
March 1, 2012 to Feb. 28, 2013
$931.01 to $1,117
$1,261.01 to $1,513
$396
March 1, 2011 to Feb. 29, 2012
$908.01 to $1,089
$1,226.01 to $1,471
$382
March 1, 2009 to Feb. 28, 2011
$903.01 to $1,083
$1,215.01 to $1,457
$374
March 1, 2008 to Feb. 28, 2009
$867.01 to $1,040
$1,167.01 to $1,400
$360
April 1, 2007 to Feb. 29, 2008
$851.01 to $1,021
$1,141.01 to $1,369
$348
April 1, 2006 to March 31, 2007
$817.01 to $980
$1,100.01 to $1,320
$340
April 1, 2005 to March 31, 2006
$798.01 to $957
$1,070.01 to $1,283
$326
August 1, 2004 to March 31, 2005
$776.01 to $931
$1,041.01 to $1,249
$318
April 1, 2004 to July 31, 2004
$776.01 to $931
$1,041.01 to $1,249
$318
April 1, 2003 to March 31, 2004
$749.01 to $898
$1,010.01 to $1,212
$314
April 1, 2002 to March 31, 2003
$739.01 to $886
$995.01 to $1,194
$308
April 1, 2001 to March 31, 2002
$716.01 to $859
$968.01 to $1,161
$302
April 1, 2000 to March 31, 2001
$696.01 to $835
$938.01 to $1,125
$290
May 1, 1999 to March 31, 2000
$687.01 to $824
$922.01 to $1,106
$282
April 1, 1998 to April 30, 1999
$671.01 to $805
$904.01 to $1,085
$280
April 1, 1997 to March 31, 1998
$658.01 to $789
$885.01 to $1,061
$272
April 1, 1996 to March 31, 1997
$645.01 to $774
$864.01 to $1,036
$262
April 1, 1995 to March 31, 1996
$623.01 to $747
$836.01 to $1,003
$256
Jan. 1, 1995 to March 31, 1995
$614.01 to $736
$820.01 to $984
$248
April 1, 1994 to Dec. 31, 1994
$614.01 to $675
$820.01 to $902
$227
April 1, 1993 to March 31, 1994
$581.01 to $639
$786.01 to $865
$226
Jan. 1, 1993 to March 31, 1993
$568.01 to $625
$766.01 to $843
$218

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

Revision 12-2; Effective June 1, 2012

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

Revision 13-3; Effective September 1, 2013

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.

Do not grant SLMB coverage for QMB applicants whose monthly income is equal to or less than the QMB limit during the three months prior through the QMB eligibility effective date.

SLMB in the three prior months is allowed with ongoing QMB if the individual’s income exceeds the QMB limits in the prior months. This situation occurs when there has been a change in countable ongoing income.

Q-3500  SLMB Eligibility and Other Programs

Revision 12-2; Effective June 1, 2012

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.