Procedures

Follow the steps below to determine SLMB eligibility.

Step 1 Accept the A/R’s SLMB application. Step 2 Contact the A/R by telephone only if information provided on the application is not sufficient to process the case. A face-to-face contact and office interview is not required at initial application or annual redetermination. Step 3 Verify Part A Medicare entitlement by one of the following: client statement, if copy of card or other written verification is not provided or available a RSDI Award Letter a Medicare card BENDEX, SOLQ under Clearinghouse on the system an MBR Query Card notification from a local SSA office If the A/R has not been approved for Part A Medicare, but is entitled to free Part A, obtain notification from SSA, scan into document imaging system and process SLMB as though the A/R is currently covered by Part A Medicare. (If an A/R is required to pay a premium to receive Part A Medicare, he/she is not considered entitled for purposes of eligibility for SLMB.) Step 4 Determine all basic eligibility criteria except LOS and LOC. Accept the A/R’s statement regarding residency. Refer to Chapter 2200, Basic Eligibility Criteria. To fulfill the TPL requirement on a SLMB applicant who has a TPL, copy the application and send to DCH only if the SLMB applicant becomes Medicaid eligible under another COA. Attach a copy of the insurance card, if available. Step 5 Determine financial eligibility using SLMB income and resource limits. Refer to Chapter 2500 - ABD Financial Responsibility and Budgeting to determine the following: whose income and resources to consider which SLMB income and resource limit (individual or couple) to use which eligibility budget to complete For all applications and annual redeterminations: The A/R’s statement of income and resources provided on the application/review form is acceptable verification . No further verification is required unless questionable. If BENDEX/SDX/SOLQ or other information known to the agency indicates a different amount from the A/R’s statement and is determined to be current, use this amount over the A/R’s statement. If a Medicare eligible couple both apply for a Q-Track COA and they are income ineligible as a couple for all Q-Track COA, calculate their eligibility as individuals for income but jointly for resources and approve each under whichever Q-Track COA they are eligible. No property search is required for this class of assistance. The Social Security number of a spouse who is not applying for benefits is not required unless eligibility cannot be established without it. Step 6 If the A/R meets all the above eligibility requirements, approve SLMB by entering the information in the current eligibility system and approve the case for SLMB. Step 7 Notify the A/R of the case disposition via the system generated notice.