0870.035.00 SLMB IN COMBINATION WITH spend down CASES

As with the QMB program, if a claimant is currently receiving non-spend down MA, the addition of SLMB Group 1 coverage may result in a spend down situation due to the loss of the deduction for payment of Medicare premiums. Remember, SLMB group 2 and 3 recipients CAN NOT receive Medicaid. Explain this option carefully to each claimant in order that s/he may make an informed decision. See QMB material in Section 0865.035.00 for a complete discussion of the effect of QMB/SLMB on spend down/non-spend down claimants.

If a SLMB Group 1 only recipient is approved for MA spend down, add the SLMB indicator (“L”) to the MA approval in Field 13M1 and the original date of SLMB eligibility in Field 13M2. The system will close the SLMB only case on the date the MA case is approved. When the spend down coverage ends, SLMB eligibility will continue.

SLMB group 2 and 3 recipients CANNOT be approved in conjunction with spend down or any other TOA providing Medicaid.