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Effective: December 1, 2006 |
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03.35.10ar1 - Service Limited Medicare Beneficiary (SLMB) (Archive) |
Archived: May 1, 2007 |
People who are enrolled or are eligible to enroll in Medicare Part A and enrolled or eligible to enroll in Medicare Part B may receive help with Medicare costs through the Service Limited Medicare Beneficiary (SLMB) program. People who meet SLMB requirements may receive SLMB only or in addition to Medical Assistance (MA).
People who are not eligible for premium-free Part A and choose to enroll in Part B only may apply for SLMB to cover the premium payment.
Medicare-eligible people are age 65 or older, blind or disabled. Some disabled people who no longer receive a cash benefit from the Social Security Administration (SSA) due to work but remain medically disabled have extended Medicare coverage and are potentially eligible for SLMB. See Medicare Savings Programs for more information on these situations.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
Follow standard MA guidelines.
SLMB benefits are available for the three months before the month of application, as well as for the application and processing months, for people who meet all eligibility requirements.
l People who apply for QMB may request SLMB for the three-month retroactive period and the processing months, as QMB is only effective after the month in which you determine QMB eligibility.
l People who qualify for QMB may not choose to receive SLMB instead on an ongoing basis.
Note: People who have income over the QMB limit but within the SLMB limit remain eligible for ongoing SLMB if they continue to meet all other SLMB requirements.
Example:
Myrtle applies for QMB on March 10. Her income is under 100% FPG and assets are within the $10,000 limit for a household of one. The earliest QMB can be opened is April.
Action:
Approve Myrtle for SLMB effective December 1 (three months before the application month). Change Myrtle’s coverage from SLMB to QMB effective April 1.
Renewals (standard guidelines)
Do not require six-month renewals for SLMB enrollees who meet any of the exceptions noted in six-month renewals.
Verify enrollment in Medicare Part A when required for SLMB eligibility.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard guidelines for federally funded MA.
Residency (standard guidelines)
Follow standard MA guidelines.
DHS pays Medicare Part B premiums through the buy-in for people who are enrolled in SLMB.
Household Composition (standard guidelines)
Follow standard MA guidelines. This includes people who are eligible for MA for Employed Persons with Disabilities (MA-EPD), the TEFRA option, or a waiver program (CAC, CADI, MR/RC, or TBI) in addition to SLMB.
Exception: Use a household size of one to determine SLMB eligibility for people who are eligible for the Elderly Waiver (EW) and for the non-EW spouse.
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.
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 standard is 120% FPG.
Deductions/Disregards (standard guidelines)
In addition to allowing the income deductions and disregards for the applicable age 65 or older, blind, or disabled status, apply the standard $20 disregard when determining SLMB eligibility. Do not allow the standard $20 disregard for MA.
Disregard RSDI cost-of-living adjustments (COLA) for January through June of each year.
Deduct allocations for the needs of relatives of an LTC client from income when determining SLMB eligibility.
There are no spenddown provisions for SLMB.
Covered Services (standard guidelines)
The benefit of the SLMB program is payment of the Medicare Part B premium.
People who are eligible for only SLMB are excluded from managed care enrollment.
Not applicable.
Eligibility for SLMB ends if the enrollee is no longer Medicare-eligible, or has excess income or assets.
People residing in Institutions for Mental Diseases (IMDs) are not eligible for SLMB unless they meet one of the conditions that allow MA eligibility in an IMD. People who would be eligible for SLMB if they did not reside in an IMD may be eligible to have their Medicare premiums reimbursed as cost-effective coverage. See Medicare premiums.
People can receive Alternative Care (AC) and SLMB at the same time.
People who are eligible for SLMB may qualify for MA concurrently with SLMB.
Note: They will need to meet a spenddown to be income-eligible for MA because of the difference in income standards for the two programs.