The Specified Low-Income Medicare Beneficiaries (SLMB) program became effective in Missouri on January 1, 1993. Effective January 1, 1998 it was expanded to cover .two additional groups of individuals. The Social Security Act referred to the new groups as Qualifying Individuals 1 (QI-1) and Qualifying Individuals 2 (QI-2). In Missouri the expansion groups are referred to as SLMB group 2 (QI-1's) and SLMB group 3 (QI-2's). The original SLMB group is now be referred to as SLMB group 1.
The SLMB group 3 (QI-2) program ended December 31, 2002.
The purpose of the SLMB program is to assist certain individuals by paying their Medicare Part B premiums, or a portion of their Medicare Part B premium. SLMB group 1 pays Medicare Part B premiums for individuals with income that makes them ineligible for QMB, more than 100% of the Federal Poverty Level (FPL), but is less than 120% of the FPL. SLMB group 2 (QI-1) 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 (QI-2) paid a portion of the Medicare Part B premium for individuals with income above 135% but less than 175% of the FPL.
The legal basis for the administration of this program is Section 1902 (a)(10)(E)(iii) of the Social Security Act and Section 208.153 (RSMO) for SLMB group 1.
For SLMB group 2 (QI-1) and SLMB group 3 (QI-2), the legal basis is Sections 1902 (a)(10)(E)(iv) and 1933 of the Social Security Act and the Balanced Budget Act of 1997. Section 1902(a)(10)(E)(IV) and Section 1933 of the Social Security Act provided for payment of a portion of Qualifying Individual 2's (SLMB-3) Medicare Part B premium from January 1998 until December 2002. Congress did not extend this program, therefore, eligibility ended December 31, 2002. Congress did extend the QI-1 program.
In order to qualify for the SLMB program a claimant must meet all eligibility requirements of the QMB program (refer to Section 0865.010.00 ),except:
(Individuals must be approved under the group with the lowest standard their income allows and be ineligible for QMB).
The SLMB income standard maximum is 135% of the Federal Poverty Level for the size of assistance group. The SLMB program has 2 groups of qualifying individuals. These individuals will be referred to as SLMB group 1 and SLMB group 2.
To qualify, income must be over the QMB standard for household size but under the SLMB standard for the same household size. Effective April 1, 2018 SLMB standards are as follows:
|Number of Persons|| SLMB Group 1
| SLMB Group 2(QI-1)
The SLMB income standard is absolute and a person may not “spenddown” to become eligible.
Claimants must be determined ineligible for QMB before an approval for SLMB can be made. The budgeting procedures for SLMB conform to QMB budgeting procedures (refer to Section 0865.010.10.25 ). Use the appropriate SLMB income standard and the QMB guidelines for determination of assistance group.
After determining that the claimant's countable income exceeds the QMB standard for household size, use the same budget figures to determine if the claimant's countable falls below the SLMB standard. If claimant's income is under the SLMB standard and all other eligibility factors are met, approve for appropriate SLMB group.
Applications are occasionally received for the buy-in programs, Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB) from applicants in Alternative Care through the Children's Division. These applications should be processed as per normal procedures. However, due to the way FAMIS is designed, the application will reject because of the applicant being in Alternative care.
Please determine if the person would be eligible for the program (income, resources, and technical criteria). A trial budget should be entered on SELWIBCA. If the person is eligible, send an email request to COLE.MHNPOLICY@dss.mo.gov with subject line "Buy-In for AC Participant". Please include in request the applicant's name, DCN, and which level of buy-in for which the person is eligible (QMB or SLMB1).
A return email will be sent when coverage has been entered. A return email will be sent when coverage has been entered. Send a manual approval letter (IM-32) to the applicant.