Page 98
Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2017 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.602 45
3. SLMB Becomes Eligible for Full Coverage When an enrolled SLMB becomes eligible in another covered group which has full Medicaid coverage, except when he/she meets a spenddown, e.g., an SLMB’s resources change to below the MN limits: • cancel the SLMB coverage effective the last day of the month immediately prior to the month in which he/she became eligible in the full coverage covered group, using cancel reason “024”; • reinstate the enrollee’s coverage with the begin date as the first day of the month in which he/she became eligible in the full coverage covered group, with the appropriate full coverage AC. 4. Spenddown Status At application and redetermination, eligible SLMBs who meet an MN covered group and who have resources that are within the lower MN resource limits are also placed on two 6-month MN spenddowns. All spenddown periods are based on the application or renewal date, as appropriate. See M1370. SLMBs who are not determined disabled must be determined disabled or blind, or must be pregnant, under age 18 or under age 21 if in foster care or adoption assistance in order to meet a medically needy covered group for spenddown. 5. SLMB Meets Spenddown When an SLMB meets a spenddown, cancel his AC “053” coverage effective the date before the spenddown was met, using cancel reason “024”. Reinstate the enrollee’s coverage with the first date the spenddown was met as the begin date of coverage, and enter the end date of the spenddown period as the end date of coverage. The AC is medically needy dual-eligible as SLMB Plus: • 024 for an aged MN individual also eligible as SLMB; • 044 for a blind or disabled MN individual also eligible as SLMB.
6. Spenddown
Period Ends After the spenddown period ends, reinstate the SLMB-only coverage using the AC 053. The begin date of the reinstated AC 053 coverage is the first day of the month following the end of the spenddown period, and the application date is the date of the original application used to determine the initial SLMB eligibility.