Section 120.70  Supplementary Medical Insurance Benefits (SMIB) Buy-In Program

a)         The Department shall pay the premium for Supplementary Medical Insurance benefits (SMIB)-(Part B of Medicare) for specified clients in accordance with the buy-in agreement with the Social Security Administration (SSA) and the Medicare Catastrophic Coverage Act of 1988 (P.L. 100-360). Individuals may previously have enrolled in SMIB themselves or they will be enrolled by the Department.

b)         Eligible Individuals

1)         The Department shall pay the SMIB premium for the following individuals:

A)        individuals who receive financial assistance (including zero grant) under the AABD or AFDC program;

B)        individuals who, except for the Social Security benefit increase of 1972 (42 CFR 435.134), would still be eligible to receive cash assistance as an aged, blind or disabled person (89 Ill. Adm. Code 113) and who are eligible for both SMIB and the Department's Medicaid program (89 Ill. Adm. Code 120);

C)        individuals with Supplemental Security Income (SSI) income who receive full Medicaid benefits under the AABD program; and

D)        Qualified Medicare Beneficiaries (QMB)s (see Section 120.72).

E)         Specified Low-Income Medicare Beneficiaries (SLIBs) (see Section 120.73).

2)         Individuals who qualify under subsections (b)(1)(A) thru (b)(1)(C) above may include individuals not eligible for Part A of Medicare (see Title XVIII of the Social Security Act).

c)         Beginning Eligibility

1)         Individuals who qualify under subsections (b)(1)(A), (b)(1)(B) or (b)(1)(C) shall be added to the SMIB Buy-in Program for the first month in which they are eligible for both SMIB enrollment and medical assistance.  Recipients shall remain in the Buy-in Program while in $0 grant status and for any month in which they qualify under (b)(1)(A) thru (b)(1)(D) above.

2)         Individuals who qualify under subsection (b)(1)(D) shall be added to the SMIB Buy-in Program for the first month following the month in which they are determined eligible for QMB status.  Recipients shall remain in the SMIB Buy-in Program for any month in which they qualify under subsection (b)(1)(A) thru (b)(1)(D) above.

3)         Individuals who qualify under subsection (b)(1)(E) may be added to the SMIB Buy-In Program effective three months prior to the month of application for SLIB benefits only or SLIB benefits and medical assistance.

(Source:  Amended at 17 Ill. Reg. 6827, effective April 21, 1993)