Section 120.73  Eligibility for Medical Payment of Medicare Part B Premiums as a Specified Low-Income Medicare Beneficiary (SLIB)

a)         Eligibility for Medicaid payment of Medicare Part B premiums exists for Specified Low-Income Medicare Beneficiaries (SLIBs).  A SLIB is an individual who:

1)         is a beneficiary of Medicare Part A (i.e. Hospital Insurance);

2)         meets the general non-financial factors of eligibility for the Medicaid Program (see Sections 120.310, 120.311, 120.319 and 120.325);

3)         has countable monthly income which exceeds the Qualified Medicare Beneficiary (QMB) income standard (see Section 120.74), but is less than or equal to the SLIB income standard (see Section 120.75); and

4)         has countable assets which do not exceed the QMB asset disregard (see Section 120.382(d)).

b)         When considering Social Security Benefits, the monthly amount to consider for January through the month following the month in which the annual Federal Poverty Level (FPL) amounts are announced will not include the annual Retirement Survivors Disability Insurance (RSDI) Cost of Living Adjustment (COLA).  For all other months of the year the full amount of RSDI benefits will be considered.

c)         SLIBs with incomes from 100 percent of the FPL up to 120 percent of the FPL may be eligible for the full range of Medicaid services (see 89 Ill. Adm. Code 140) only if they meet all eligibility requirements for Medicaid (see 89 Ill. Adm. Code 120).

d)         Individuals with incomes of at least 120 percent of the FPL but less than 175 percent of the FPL, who receive Medicaid benefits, are not eligible for the benefits described in subsection (g) of this Section.

e)         Eligibility for Medicaid Payment of Medicare Part B premiums may be effective up to three months prior to the month of application.

f)          Eligibility for SLIB status will be redetermined at least every 12 months.

g)         SLIBs with incomes from 100 percent of the FPL up to 135 percent of the FPL are eligible for Medicaid payment of Medicare Part B premiums (see Title XVIII of the Social Security Act), in accordance with Sections 120.70 and 89 Ill. Adm. Code 140.21.  Individuals with incomes from 135 percent of the FPL up to 175 percent of the FPL are not eligible for Medicaid payment of Part B Medicare premiums.  These persons are only eligible for a monthly payment that is for the portion of Medicare cost sharing described in the Social Security Act (U.S.C. 1905(p)(3)(A)(ii)).

(Source:  Amended at 22 Ill. Reg. 8503, effective May 1, 1998)