Ill. Admin. Code tit. 89 § 120.70

Current through Register Vol. 48, No. 49, December 6, 2024

Section 120.70 - Supplementary Medical Insurance Benefits (SMIB) Buy-In Program

a) The Department shall pay the premium for Supplementary Medical Insurance benefits (SMIB) (Part B of Medicare) for specified clients in accordance with the buy-in agreement with the Social Security Administration (SSA) and the Medicare Catastrophic Coverage Act of 1988 ( P.L. 100-360). Individuals may previously have enrolled in SMIB themselves or they will be enrolled by the Department.

b) Eligible Individuals

1) The Department shall pay the SMIB premium for the following individuals:

A) individuals who receive financial assistance (including zero grant) under the AABD or TANF program;

B) individuals who, except for the Social Security benefit increase of 1972 ( 42 CFR 435.134) , would still be eligible to receive cash assistance as an aged, blind or disabled person (89 Ill. Adm. Code 113) and who are eligible for both SMIB and medical assistance;

C) individuals with Supplemental Security Income (SSI) income who receive full Medicaid benefits under the AABD program;

D) Qualified Medicare Beneficiaries (QMBs) (see Section 120.72 );

E) Specified Low-Income Medicare Beneficiaries (SLIBs) (see Section 120.73(b) ); and

F) to the extent federal matching funds are available, Qualified Individuals-1 (QI-1) (see Section 120.73(c) ) .

2) Individuals who qualify under subsections (b)(1)(A) through (b)(1)(C) may include individuals not eligible for Part A of Medicare (see Title XVIII of the Social Security Act).

c) Beginning Eligibility

1) Individuals who qualify under subsection (b)(1)(A), (b)(1)(B) or (b)(1)(C) shall be added to the SMIB Buy-in Program for the first month in which they are eligible for both SMIB enrollment and medical assistance. Recipients shall remain in the Buy-in Program while in $0 grant status and for any month in which they qualify under subsections (b)(1)(A) through (b)(1)(D).

2) Individuals who qualify under subsection (b)(1)(D) shall be added to the SMIB Buy-in Program for the first month following the month in which they are determined eligible for QMB status. Recipients shall remain in the SMIB Buy-in Program for any month in which they qualify under subsections (b)(1)(A) through (b)(1)(D).

3) Individuals who qualify under subsection (b)(1)(E) may be added to the SMIB Buy-in Program effective three months prior to the month of application for SLIB or QI-1 benefits only or SLIB or QI-1 benefits and medical assistance. For persons for whom an electronic application from the Social Security Administration (SSA) (pursuant to 89 Ill. Adm. Code 110.10(a)(2) ) is received and who the Department determines qualify as SLIBs or QI-1s, eligibility may begin up to three months prior to the application with SSA for low income subsidies (LIS) under 42 USC 1395w-114, as that application date is indicated in the electronic transmission to the Department from SSA. Eligibility for each of the three months prior to the LIS application must be established.

Ill. Admin. Code tit. 89, § 120.70

Amended at 36 Ill. Reg. 4133, effective March 1, 2012