0870.040.00 QMB TO SLMB CASES

QMB recipients who receive an increase in countable income that makes them ineligible for QMB may become SLMB eligible. In this situation, the beginning date of coverage for SLMB may not overlap the QMB eligibility end date. Use the following procedures to establish SLMB eligibility.

1. QMB-Only Case to SLMB-Only Case
   • Register a SLMB application using “SLMB” type of assistance from IAPP.
   • Determine eligibility for SLMB on all factors including income;
   • In IMU5 on the “Q” case, enter closing code 29, and;
   • Enter an “L” or “2” or “3” in Field 13M1 and the following month as the SLMB begin date in Field 13M2. NOTE: The system will only allow an entry of the month following the month of the transaction. Failure to enter the following month will result in an on-line edit. They system will determine the QMB end-date to appear in IXIX. This establishes SLMB eligibility and is, in effect, an approval for SLMB. Do not make this entry unless SLMB eligibility has been determined on all factors.

     If the net income in Field 34 of IMU5 exceeds the SLMB income standard for household size, the system will not allow an entry of “L” or “2” or “3” in Field 13M1 (approval for SLMB). An edit occurs stating “INCOME EXCEEDS SLMB STANDARD”. Additionally, if the income figure in Field 34 is less than the QMB standard for household size, and edit occurs stating “INCOME LESS THAN QMB STANDARD”.

   • The system will automatically open the SLMB only case when it closes the QMB case. This automatic process is necessary to prevent a break in buy-in coverage.
   • Data Processing will generate notice IM-32(SLMB) to the claimant to provide notice of approval for SLMB and denial of QMB.
2. Combination QMB/Other Type of Assistance Becomes Combination SLMB Group 1/Other Type of Assistance

   If an individual is receiving QMB and another type of assistance, and loses eligibility for QMB due to an increase in income that is above the QMB standard but below the SLMB group 1 standard for household size, take the following action:

   • Register a SLMB application using “SLMB” type of assistance from IAPP.
   • Using the IM-5 for the other type of assistance, enter an action code “35” for an adjustment. Enter an “L” in Field 13M1 and the following month as the begin date of SLMB group 1 eligibility in Field 13M2. NOTE: The system will only allow an entry of the month following the month of the transaction. Failure to enter the following month will result in an on-line edit. The system will determine the QMB end-date to appear in IXIX. This establishes SLMB eligibility and is, in effect, an approval for SLMB. Do not make this entry unless SLMB group 1 eligibility has been determined on all factors.
   • Data Processing will generate notice IM-32(SLMB) to the claimant to provide notice of approval for SLMB and denial of QMB. Inform the claimant that coverage for the other type of assistance is unaffected.

0870.045.00 EFFECT OF COLA INCREASES ON SLMB CASES

As with the QMB program, federal legislation stipulates that OASDI cost of living increases which are received in January of each year cannot be considered on SLMB budgets until the effective date of the new Federal Poverty guidelines in April of each year.

1. SLMB Applications Taken January Through March

   For SLMB applications effective for the months of January through March, verify the amount of OASDI received in December. Use this amount in determining eligibility for SLMB for those months. In April, SLMB cases will be mass adjusted to reflect the COLA increase. If the OASDI COLA increase causes ineligibility, the case will be closed at that time or moved to a different group.

2. Prior Quarter Coverage Before April

   If a SLMB application is approved for prior quarter coverage that includes the months January through March, do not use the increased OASDI amount for the applicable prior quarter months. Verify the December OASDI and use it for the appropriate prior quarter months.