SLMB only covers the Medicare Part B premium, so make sure the client is on Part B. If the client was on Part B three months prior to the date of application, the case can be certified to cover those three months if the client meets all factors of eligibility in each month.

An application can be used to cover the month of application or the very next month. If the client goes on Medicare after that, the current application will have to be denied and the client told to come back the month before s/he goes on Medicare.

If the client is eligible for a medical benefit through Special Medical or Long Term Care, you will certify the case based on those programs then add the SLMB benefit.

NOTE: Cases that were previously or are currently used for active TANF benefits should not be used for ABD and buy-in benefit cases.

Eliza Johnson came into the DHS office on 10/16/2017 because she went on Medicare Part B that month. She received $1190 a month in RSDI. Her only reported resource is a checking account with a verified balance of $237. She meets the income and resource standards for SLMB.

Household tab:

• Make sure the name, date of birth, gender and Social Security Number match what is in BENDEX. She started on Medicare in 10/2017.
• Benefit: SLMB-Specified Low Income Medicare Beneficiary
• Status: Added to Benefit Section
• Effect Date: 10/01/2017
  

Note: No medical line is needed if the benefit is only for SLMB. A medical line is used if the client is eligible for a medical program such as ADvantage, Nursing Facility Services, or Special Medical.

Income tab:

• Make sure the Social Security Claim Number match what is in BENDEX.
• RSDI blocks, Declared Monthly Amt: $1190
• How Often Paid: Monthly
• Receiving: check box for “yes”
• Countable Amt: $1190
• SSN Claim Number: 999993993A
  

Resource tab:

• Does anyone have any liquid resources or assets?: Click in the box one for “yes”
• Liquid Resource Type: Checking
• Balance: $237
• Where Located: First Bank of Indio
• Account Number: 333222111
• Resource Type: Savings Which Include Cash, Bank Accounts, Bonds, Stocks, Etc.
• Countable Amt: $237
  

Medical General tab:

• Type Action Taken: Certified or Online Enrollment Sent to OHCA
• Reason: Select appropriate reason. Refer to Appendix R.
• Application Date: 10/16/2017
• Certification/Disposition Date: 10/01/2017
• Certification Period: 12 (must be 12 or buy-in won’t work)
• Effective Months: 99
• Adv Notice Req: No
• Date of Last Redetermination: 10/01/2017 (must match Certification Date)
  

Medical Financial tab:

• Medical Application Reason: SSP or Disability has already been established by SSA
• Medial Application Source: CO-County Office