SLMB Only definition

SLMB Only means a SLMB does not qualify for any additional Medicaid benefits.

SLMB Only. The member’s benefits are limited to payment of the member’s Medicare Part B premium only. Specified Low-Income Medicare Beneficiary Plus (SLMB+): The member’s benefits include payment of the member’s Medicare Part B premium in addition to Traditional Medicaid benefits throughout each month of eligibility, including deductibles, co-insurance and co-pays (except for Part D). Qualifying Individual (QI): The member’s benefit is payment of the member’s Medicare Part B premium. The Eligibility Verification System (EVS) identifies this coverage as Qualified Individual. Qualified Disabled Working Individual (QDWI): The member’s benefit is payment of the member’s Medicare Part A premium. The EVS identifies this coverage as Qualified Medicare Beneficiary.

SLMB Only is an individual (i) who is entitled to Medicare Part A benefits; (ii) who has annual income that exceeds 100% FPL but is less than 120% FPL; and (iii) whose resources do not exceed twice the SSI limit. Under the Medicaid State Plan, a SLMB is eligible for financial assistance from the Agency in connection with certain Medicare benefits, including payment of Medicare Part B premiums.

Examples of SLMB Only in a sentence

• The Medicaid eligibility categories encompass all categories of Medicaid eligibility including: • Full Medicaid (only); • Qualified Medicare Beneficiary without other Medicaid (QMB Only); • QMB Plus; • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only); • SLMB Plus; • Qualifying Individual (QI); and • Qualified Disabled and Working Individual (QDWI).

• CMS strictly prohibits Balance Billing. SLMB Only (Specified Low Income Medicare Beneficiary)/ Medicaid Status Code 03: Medicare copay not covered. SLMB+ (Specified Low Income Medicare Beneficiary plus Full Medicaid)/Medicaid Status Code 04: Conditional – verify Medicaid DME benefits and bill Medicaid for the Medicare copay when covered. QDWI (Qualified Disabled and Working Individuals)/Medicaid Status Code 05: Medicare copay not covered.

• Benefit Individuals who apply for SLMB Only get payment (Buy-in) only for their Medicare Part B premium and no other benefits.

• The categories of dual eligible members for D-SNPs include the following: QDWIs, QMB Only, QMB Plus, QI, SLMB Only, SLMB Plus, and Other FBDEs. Dual Eligible Special Needs Plan (D-SNPs).

• Units for rebatable drugs furnished to Medicare beneficiaries with Medicaid coverage that does not include cost-sharing assistance (i.e., SLMB Only, Qualified Disabled and Working Individuals (QDWI), and Qualifying Individuals (QI) beneficiaries) will be included in rebate calculations.

• The Medicaid eligibility categories encompass all categories of Medicaid eligibility including: • Full Medicaid (only); • Qualified Medicare Beneficiary without other Medicaid (QMB Only); • QMB Plus; • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only); • SLMB Plus;• Qualifying Individual (QI); and • Qualified Disabled and Working Individual (QDWI).

• Like a SLMB Only, a SLMB Plus is an individual who is entitled to Medicare Part A, has income between 100 and 120 percent of the FPL, and whose resources do not exceed three times the SSI limit.