IM-49 05-11-98 SLMB EXPANSION
|SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES
MANUAL REVISION # 11, (CHAPTER VI, Section XV, PAGES 105-113).
|The Balanced Budget Act of 1997 contains
a provision for the expansion of the SLMB program for two new groups of
individuals. The SLMB program expansion is effective January 1, 1998.
Qualifying individuals for the expansion program will be referred to as
SLMB group 2 and SLMB group 3. The current SLMB program will now be referred
to as SLMB group 1. SLMB group 2 pays Medicare Part B premiums for
individuals with income that makes them ineligible for SLMB group 1, but
is less than 135% of the Federal Poverty Level (FPL). SLMB group
3 pays a portion of the Medicare Part B premium for individuals with income
above 135% but less than 175% of the FPL.
Effective May 4, 1998, Data Processing will generate IM-32 (SLMB) approval letters for all SLMB groups (see attached examples). The letter will notify the claimant of ineligibility for QMB. If the claimant is approved for group 3, the letter will also inform the claimant of ineligibility for SLMB group 2. The system WILL NOT generate approval letters for any other type of assistance approved in conjunction with a SLMB group 1 approval.
Eligibility requirements for the new SLMB groups are the same as for regular SLMB (group 1) with the following exceptions:
SLMB group 2 recipients receive payment of their Medicare Part B (SMI) premium. Although this is the same benefit as regular SLMB, SLMB group 1 and SLMB group 2 recipients must be identified separately because of a difference in funding. Medicare Part B premiums for SLMB group 2 eligibles are paid through the Buy-In procedure the same as regular SLMB. The initial buying-in process takes 60-90 days to complete.
Group 3 recipients receive payment of a portion of their Medicare Part B (SMI) premium as the only benefit. For calendar year 1998 group 3 qualifying individuals will receive $1.07 per month, this amount should increase each calendar year. These individuals will be issued one check in December of each year for that portion of the SMI premium for each month they were eligible.
SLMB recipients do not receive a Medicaid card or have coverage for any Medicaid services.
There is an annual limit on available funds for SLMB groups 2 and 3. However, once approved, a claimant is guaranteed benefits through December of the year approved. In December of each year, the Division of Medical Services will determine if there is enough funding available to continue all eligible SLMB group 2 and 3 recipients for the next year. Recipients will be sent a system generated letter notifying them if their benefit will continue or end. At this time it does not appear that we will exceed our state allocation. If, in the future, it appears that we may exceed the allocation, further instructions will be issued.
SLMB Income Standards and Budgeting Procedures
The budgeting procedures for the new SLMB
groups are the same as for the regular SLMB program. Use the income
standards below to determine if the claimant is eligible for regular SLMB
or in one of the expansion groups.
Beginning Date of SLMB Coverage
All SLMB applicants are approved for the month of application if eligible. Additionally, all SLMB applicants may be approved for prior quarter coverage if all eligibility criteria including income are met. Prior quarter coverage may not begin prior to January 1, 1998, for groups 2 and 3, and may not overlap QMB or SLMB group 1 coverage.
NOTE: For the begin date on a case switching from QMB/SLMB to SLMB group "2" or "3" expansion, see procedures later in this memorandum.
All SLMB applications are identified as "L" type of assistance. The new groups are distinguished from regular SLMB by an indicator in Field 13M1 on the IMU5.
L - indicates eligibility for SLMB group 1, income between 100 and 120% of FPLField 13M2 is unchanged. Continue to use Field 13M2 to indicate the beginning date of eligibility for the program identified in Field 13M1.
The following edits have been added to IMU5:
When a SLMB group 1 or 2 recipient receives an increase in countable income that makes them ineligible for the group they are in, determine if they remain income eligible for one of the other groups. In this situation, the beginning date of coverage for SLMB group 2 and 3 may not overlap the SLMB eligibility end date.
If they are eligible enter a "2" or "3" in Field 13M1 and the following month as the begin date for that group in Field 13M2. The system will determine the end-date for their previous group.
If a claimant reports a change that establishes ineligibility for SLMB, close the case using regular IMU5 procedures. Additionally, the system requires an entry of "N" in Field 13M1 to close the SLMB case. Failure to make an entry in this field results an on-line edit as above.
Send the claimant notification as appropriate in the above situations. Use IM-80 procedures when taking any adverse action, including those situations where an individual moves from group 2 to group 3.