Service Limited Medicare Beneficiary (SLMB)

The Service Limited Medicare Beneficiary (SLMB) program will pay Medicare Part B premiums for people who meet the requirements of Qualified Medicare Beneficiary (QMB), but have excess income. People may receive SLMB alone or in addition to Medical Assistance (MA).

People may apply for SLMB to cover the Medicare Part B premium payment even if they choose not to take Medicare Part A.

See Medicare for more information about eligibility criteria for Medicare. See Medicare Savings Programs for more information about eligibility for Medicare Savings Programs.

Eligibility factors and links to standard program guidelines are provided below.

Application Process.

Eligibility Begin Date.

Renewals.

Verifications.

Social Security Number.

Citizenship/Immigration Status.

Residency.

Insurance and Benefit Recovery.

Household Composition.

Eligibility Method.

Asset Guidelines.

Income Guidelines.

Deductions/Disregards.

Spenddowns.

Covered Services.

Service Delivery.

Other Requirements.

End of Eligibility Basis.

Relationship to Other Groups/Bases.

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Application Process  (standard guidelines)

Follow standard MA guidelines.

Eligibility Begin Date  (standard guidelines)

SLMB benefits are available for the three months before the month of application for people who meet all eligibility requirements.

People eligible for ongoing QMB may receive SLMB for the three-month retroactive period, the month of application and all months preceding the month QMB eligibility begins if all other eligibility requirements are met.

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Renewals  (standard guidelines)

Do not require six-month renewals for SLMB enrollees who meet any of the exceptions noted in six-month renewals.

Verifications  (standard guidelines)

Verify enrollment or eligibility to enroll in Medicare Part A.

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Social Security Number  (standard guidelines)

Follow standard MA guidelines.

Citizenship/Immigration Status  (standard guidelines)

U.S. citizens who are enrolled or eligible to enroll in Medicare are not required to provide citizenship or identity documentation.

For noncitizens, follow standard guidelines for federally funded MA.

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Residency  (standard guidelines)

Follow standard MA guidelines.

Insurance and Benefit Recovery  (standard guidelines)

DHS pays Medicare Part B premiums through the Medicare buy-in for people who are enrolled in SLMB.

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Household Composition  (standard guidelines)

Follow standard MA guidelines to determine household size for SLMB eligibility even if a household size of one is used for MA for Employed Persons with Disabilities (MA-EPD), the TEFRA option, or a waiver program for people with disabilities (CAC, CADI, DD or BI).

Example:

Chris applied for SLMB and MA with the CADI waiver. He lives with his wife, Joan, and their four children.  

Action:

Use a household size of six for SLMB. Use a household size of one for MA/CADI.

Always use a household size of one to determine SLMB eligibility for a person who is eligible for the Elderly Waiver (EW).

Example:

Sue applies for EW and is eligible for Medicare. She lives with her husband Greg.  

Action:

Determine Sue’s eligibility for both EW and SLMB using a household size of one.

Follow standard MA guidelines in Determining Household Size for MA to determine which household members to count in the household size when determining the SLMB eligibility for a person who is not requesting EW, but has a spouse who is on EW. However, do not count the person’s spouse in the household size if the spouse is on EW. See Exceptions to MA Household Size.

Example:

Jack is on EW and is eligible for Medicare. He lives with his wife, Wendy, and their 17-year-old daughter Mary. Wendy is eligible for Medicare and is not requesting EW.

Action:

Determine Jack’s eligibility for both EW and SLMB using a household size of one. Determine Wendy’s eligibility for SLMB using a household size of two (Wendy and Mary).

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Eligibility Method  (standard guidelines)

Use Method B for income and assets.

Note:  If people who are also eligible for MA meet more than one basis of eligibility, they may choose the most advantageous basis for MA, but must use a Method B basis for the Medicare savings program.

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Asset Guidelines  (standard guidelines)

Asset limit is:

l  $10,000 for a household of one.

l  $18,000 for a household of two or more.

Income Guidelines  (standard guidelines)

Income standard is 120% FPG. Income eligibility is determined on a monthly basis. SLMB does not have a six month or annual standard.

Example:  

Myrtle is paid bi-weekly through her employer. In December, she will receive three paychecks and her income will be higher than the 120% FPG standard.

Action:

Myrtle’s total net income exceeds the standard in December. She is ineligible for SLMB in December.

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Deductions/Disregards  (standard guidelines)

Apply the standard $20 disregard in addition to allowing the income deductions and disregards for the applicable age 65 or older, blind, or disabled status basis when determining SLMB eligibility.

Disregard RSDI cost-of-living adjustments (COLA) for January through June of each year.

Exclude Aid and Attendance benefits and Allowances for Unusual Medical Expenses received from the Veteran’s Administration.

When a person is in a long-term care facility (LTCF), use a long-term care budget to determine their MA eligibility and a Medicare Savings Program budget to determine SLMB eligibility.

Spenddowns  (standard guidelines)

There are no spenddown provisions for SLMB.

Example:

Bud’s income is 150% FPG. He is ineligible for SLMB even if he has medical expenses that would allow him to spend down to 120% FPG.

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Covered Services  (Prepaid MHCP Manual)

SLMB pays the Medicare Part B premium.

Service Delivery  (Prepaid MHCP Manual)

People who receive only SLMB are excluded from managed care enrollment.

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Other Requirements

Not applicable.

End of Eligibility Basis

Eligibility for SLMB ends if the enrollee is no longer Medicare-eligible, or has excess income or assets.

A person who becomes eligible for QMB may not receive SLMB. See QMB Eligibility Begin Date for more information.

Relationship to Other Groups/Bases  (standard guidelines)

See Medicare Savings Programs for general information about the relationship between MSPs and other program eligibility.  

People who are eligible for SLMB may qualify for MA concurrently with SLMB.

They may need to meet a spenddown A cost-sharing method available to people who do not qualify for MA because of excess income. People may become eligible by incurring medical expenses equal to or greater than the excess income. There are several types of spenddowns including monthly, six-month, LTC and combination LTC/medical. to be income-eligible for MA because of the difference in income standards for the two programs.

Note:  The Part B premium cannot be used to meet a spenddown if SLMB is open.

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