Specified Low-Income Medicare Beneficiary (SLMB) Program

Individuals with income greater than the QMB income limit (100% of the Federal Poverty Level), but less than or equal to the SLMB income limit (120% of the Federal Poverty Level), are eligible for payment of their Medicare Part B premium under the SLMB Program.

Application or eligibility for MC is not required to qualify and be eligible for SLMB.

Effective Date

Eligibility begins the month of application if all eligibility requirements are met. Unlike QMB, clients may apply for 3-month retroactive SLMB.

Benefit

Individuals who apply for SLMB Only get payment (Buy-in) only for their Medicare Part B premium and no other benefits. SLMB does NOT pay for one's Medicare Part A premium, or for Part A and B deductibles and coinsurance.

SLMB only recipients do not receive a MC BIC.

Once State Buy-In of their Medicare Part B premium begins, the premium will not be deducted from their Social Security check. They will have an increase in their monthly net income.
SLMB eligibility can be viewed on MEDS, Aid Code '8C' on the Special Program screen.

Individuals who qualify for Medicare Part B may apply for it at any time at the Social Security office. That is, if they refused Part B coverage during their “initial enrollment period” they do not have to wait until SSA's “general enrollment period” (January - March) to apply.

Eligibility Criteria

SLMB applicants/recipients must meet all of the following eligibility criteria:

Medicare Part A

Is eligible for Medicare Part A, either free or they pay for it.

Important: Conditional” Medicare Part A applications are not allowed in the SLMB Program. SLMB applicants must be eligible for Part A free or pay their own Part A premium in order to be potentially eligible for SLMB. “Conditional” Medicare Part A only applies to the QMB Program.

Property

The property limit is the same as QMB, prior to 1/1/2010, twice the Medi-Cal property limit:

$4,000 for one individual
$6,000 for two individuals

As of 1/1/2010 the property limit is three times the Supplemental Security Income property limit, plus an annual percentage increase equal to the increase in Consumer Price Index (CPI).

Income

SLMB eligibles must have income in excess of the QMB income limit, but less than the SLMB income limit:

110% of the Federal Poverty Limit in 1993 and 1994.
120% of the Federal Poverty Limit in 1995 and continuing.

Citizen/ Non-citizen Status

SLMB eligibles must be a citizen or a Non-citizen who would otherwise be entitled to full-scope benefits if applying for regular MC. An undocumented Non-citizen who would only get restricted MC benefits is not eligible for SLMB.

Other Requirements

SLMB applicants/recipients must meet all other Medi-Cal Program requirements, including:

Providing any necessary verifications. (IEVS is required.)
Completing an annual redetermination.
Reporting any changes within 10 days. (Income reports are not required for ABD-MN households.)
Maintaining California residency.

Dual Eligibility

If the client is eligible for MC and has income below 100% FPL, there is no need to set up SLMB as the buy-in for Part B will be initiated once MC eligibility is authorized and the MBI/HIC number is entered.

ABD-MN

EWs must identify SLMB eligibility for those persons who qualify for regular Medi-Cal ABD-MN benefits, have Medicare Part A and B, and whose income is over the QMB income limit but below the SLMB income limit.

These “dual eligibles” (ABD-MN and SLMB) will receive their regular plastic Benefits Identification Card (BIC). However, the SLMB aid code 8C will be reported to MEDS so that the state can receive federal funding for their Part B Buy-In.

SSI/SSPs, SLMB Does NOT Apply

Individuals receiving SSI/SSP are not eligible for SLMB. In addition, EWs will not identify SLMB eligibility for individuals who are receiving IHSS or who are Pickle eligible. (The state already receives federal funding for Buy-In for these individuals.)

When to Evaluate

EWs are required to determine the level of benefits each Medi-Cal applicant is entitled to, explain the options (including spenddown), establish benefits and the appropriate notices of action.

ABD-MN recipients must be reviewed for SLMB “dual eligibility” at the following times:

At RD, or
When there is a change in income, or
When there is a change in the SLMB income limit. (The SLMB income limit changes annually in April due to the Federal Poverty Level (FPL) changes.)

NOAs

SLMB Only

Approval, denial and discontinuance NOAs are required for SLMB Only individuals.

ABD-MN and SLMB (Dual Eligibles)

No SLMB NOAs are to be issued to dual eligibles.