Medicaid Policy
Medicaid Policy
A. SLMB for Medicare Part B
The benefit for SLMB pays the Medicare Part B premium only.
Members may receive SLMB and other Medicaid programs (except AEM or TAM) at the same time. Explain to members that SLMB only pays the Part B premium. SLMB does not pay the Medicare Part B deductible or co-payments. If the member becomes eligible for Medicaid by paying a spenddown, Medicaid will pay the Medicare deductibles and co-payments. Medicaid may also cover medical services that Medicare does not cover.
The TPL process is required (225).
The effective date for coverage is the first day of the application month or the first day of any of the 3 retroactive months in which the individual meets all the requirements for SLMB. See 705-1 to determine the retroactive period. Always review eligibility for the retroactive months.
B. SLMB for Medicare Part B-ID
The benefit for SLMB pays the Medicare premium for Part B-ID only.
If a SLMB member is eligible for other Medicaid programs, Marketplace insurance, or employer insurances that cover immunosuppressant drugs, they are not eligible for the SLMB Part B-ID program.
The TPL process is required (225).
The effective date for coverage is the first day of the application month or the first day of any of the 3 retroactive months in which the individual meets all the requirements for SLMB. See 705-1 to determine the retroactive period. Always review eligibility for the retroactive months.