Effective Date: March 1, 2026
Previous Policy
A. SLMB for Medicare Part B
The benefit for SLMB pays the Medicare Part B premium only.
Members may receive SLMB and other Medicaid programs (except AEM or TAM) at the same time. Explain to members that SLMB only pays the Part B premium. SLMB does not pay the Medicare Part B deductible or co-payments. If the member becomes eligible for Medicaid by paying a spenddown, Medicaid will pay the Medicare deductibles and co-payments. Medicaid may also cover medical services that Medicare does not cover.
The TPL process is not required ( 225 ).
The effective date for coverage is the first day of the application month or the first day of any of the 3 retroactive months in which the individual meets all the requirements for SLMB. See 705-1 to determine the retroactive period. Always review eligibility for the retroactive months.
B. SLMB for Medicare Part B-ID
The benefit for SLMB pays the Medicare premium for Part B-ID only.
If a SLMB member is eligible for other Medicaid programs , Marketplace insurance, or employer insurances that cover immunosuppressant drugs, they are not eligible for the SLMB Part B-ID program.
The TPL process is required ( 225 ).
The effective date for coverage is the first day of the application month or the first day of any of the 3 retroactive months in which the individual meets all the requirements for SLMB. See 705-1 to determine the retroactive period. Always review eligibility for the retroactive months.