Eligibility Online Manual
Purpose: This section will assist in determining whether an individual is eligible for Specified Low-Income Medicare Beneficiary (SLMB).
Current Policy Effective Date: November 1, 2015
Date Last Reviewed: November 16, 2015
Previous Policy: December 1, 2011
POL M1102: DETERMINING ELIGIBILITY FOR SLMB
1. Applicants Must Meet Basic Eligibility Factors
Refer to Section M600 for a description of all basic eligibility factors.
2. Applicants Must Be Entitled To Part A And Part B Medicare Insurance
3. Applicants Must Meet Income Requirements
Require the countable income to be within the maximum income standard of more than 100% FPL and less than or equal to 135% FPL. Assistance unit size of two must not be exceeded. Refer to Medicaid Table 1. Refer to Section M905 for Income Disregards/Deductions.
4. Applicants Must Meet Resource Requirements
5. Medicaid Will Pay Some Premiums
Medicaid will pay Medicare Part B premiums.
In addition, clients may receive assistance with their Medicare Part D premium payments from the Centers for Medicare and Medicaid Services (CMS).
Clients will not receive a Medicaid card.
6. Applicants May Receive Retroactive Premium Payment
Applicants may receive retroactive premium payments for any of the three months prior to application.
Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.
7. Benefits Begin First Day Of The Month
8. Clients Must Be Reviewed
Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.
Clients must be reviewed for other Medicaid program eligibility before closing cases.
9. Clients May Lose Benefits
The case will close on the first day of the next month when any of the following occur:
Client does not complete review.
Client enters a public institution.
Client determined no longer eligible.
Defining Group: Social Security Act §1902(a)(10)(E)
Social Security Act §1905P
Balanced Budget Act of 1997 Section 4732
Income: 20CFR 416 Subpart K
Resources: 20CFR 416 Subpart L
1. SLMB is defined as a beneficiary covered under the Medicare Catastrophic Coverage Act (MCCA) of 1998.
2. Resource Transfer Provisions Do Not Apply.
3. Compare total countable income to the single standard in Medicaid Table 1 when the income of the ineligible spouse is not deemed.
1. Finalize Eligibility and close benefits in WES when the applicant is no longer eligible.
2. Allow 15-day closure notice when an adverse action has occurred.