16 Del. Admin. Code § 17000-17400
Section 4501(b) of the Omnibus Budget Reconciliation Act (OBRA) of 1990 mandates coverage of specified low-income Medicare beneficiaries beginning January 1, 1993. Medicaid will pay the Medicare Part B premium for these individuals. They do not receive any Medicaid services.
A Specified Low-Income Medicare Beneficiary (SLMB) is an individual who meets all of the eligibility requirements for Qualified Medicare Beneficiary (QMB) status except for income in excess of the QMB income limit Follow all technical and financial eligibility requirements (except for income limits) described in the QMB program.
The income limit is 110% of the Federal Poverty Level for calendar years 1993 and 1994. Effective for calendar years beginning 1995, the income limit is 120% of the FPL. The new poverty levels are effective April 1 for SLMBs who have title II income. For SLMBs without title II income, the new poverty levels are effective February 1.
Social Security COLA increases will be excluded in determining the eligibility of recipients during the first three months of a calendar year.
Retroactive eligibility does apply to this group unlike the QMB program. Benefits may begin with the month of application. Retroactive coverage is available for the three months prior to the month of application.
A redetermination of eligibility must be completed at least every 12 months. We will promptly redetermine eligibility when information is received about changes in circumstances that may affect eligibility.
16 Del. Admin. Code § 17000-17400