Process applications within 45 days from the date of application, except in unusual circumstances. If the application is not processed within the 45 day time frame, IMU5 entry of an appropriate delay code is required.
Unlike the QMB program, SLMB applicants are approved for the month of application if eligible. Additionally, SLMB applicants may be approved for prior quarter coverage if all eligibility criteria including income are met.
A claimant cannot receive SLMB coverage if his/her income is under the QMB maximums. For example, if the claimant is determined SLMB eligible for the current month and ongoing, but had income under the income limits for QMB in the prior quarter, do not give SLMB coverage for prior quarter, or other months prior to beginning of QMB coverage.
Likewise, when income increases or decreases causing a change from one SLMB group to another, the beginning date of the new group coverage should not overlap the end of the previous coverage.
NOTE: For the begin date of a case switching from QMB to SLMB, see procedures under QMB to SLMB Cases.
SLMB applications are identified as “L” type of assistance. They are further distinguished from QMB's by and indicator in Field 13M1. Use the following indicators in Field 13M1.
L - indicates eligibility for SLMB group 1,
2 - indicates eligibility for SLMB group 2,
3 - indicates eligibility for SLMB group 3,
N - indicates eligibility for neither program.
Field 13M2 is unchanged. Continue to use Field 13M2 to indicate the beginning date of eligibility for the program identified in Field 13M1.
When 13M2 is unchanged. Continue to use Field 13M2 to indicate the beginning date of eligibility for the program identified in Field 13M1.
When a claimant requests an application for SLMB or QMB, take an application for both. Remember: A claimant must be ineligible for QMB to be approved for the SLMB program. Always take application for both SLMB and QMB if the claimant requests either program.
Determine eligibility for SLMB assistance as instructed above. All regular IM application procedures, such as the use of the IM-1, IM-2, and IM-3, and availability of administrative hearings apply.
SLMB applications may be taken in conjunction with any other type of assistance. To process a SLMB approval, use on of the following procedures:
NOTE: SLMB groups 2 and 3 application CAN NOT be approved in conjunction with any other type of assistance providing Medicaid. An on-line edit will occur if an individual(s) is active on another type of assistance.
Take the following steps to approve SLMB only cases:
Take the following steps to approve SLMB in combination with another type of assistance:
If the claimant makes application for QMB, SLMB and another type of assistance, as above, and is determined eligible for the other type of assistance and QMB reject the SLMB application using the reason for rejection code 59, “approved for QMB”. The system will not automatically reject the SLMB application.
Completion of the IMU5 for the SLMB program follows QMB instructions in the following situations:
If the net income in Field 34 exceeds the income standard for household size an edit occurs stating “INCOME EXCEEDS SLMB STANDARD”. Take action to review the case for SLMB “2” or “3” eligibility before rejecting the application.