Q-4100, SLMB Dual Eligibility and Medicare Buy-In

Revision 13-4; Effective December 1, 2013

Programs ME-Pickle, ME-SSI Prior, ME-Temp Manual SSI, ME-SSI, ME-Disabled Adult Child, MC-QMB, and ME-A and D-Emergency cannot be dually eligible for SLMB. Even though ME-Pickle and ME-Disabled Adult Child recipients may meet SLMB eligibility requirements, the Medicare Part B premium is already paid because they are on Medicaid.

Q-4200, Texas Works Medicaid and QMB or SLMB Dual Eligibility

Revision 20-2; Effective June 1, 2020

Persons receiving Medicaid benefits through Texas Works Medical Programs also may qualify for QMB benefits.

These programs include the following:

  • MA – Earnings Transitional (TP 07)
  • MA – Parents and Caretaker Relatives (TP08)
  • MA – Pregnant Women (TP 40)
  • MA – Children Under 1 (TP 43)
  • MA – Newborn Children (TP 45)
  • MA – Children 1-5 (TP 48)
  • MA – Children 6-18 (TP 44)
  • MA – Former Foster Care Children (FFCC) (TA 82)

The above programs cannot be dually eligible for SLMB. Even though these programs may meet SLMB eligibility requirements, the Medicare Part B premium is already paid.

A person receiving (TP-56) MA-Medically Needed Spend Down can be eligible for MC-SLMB.

Note: There is no prior coverage for QMB unless income during a specific prior month is over the QMB limit and is within the SLMB income limit criterion.

Related Policy

Medicare Savings Programs, A-8000

Q-4210 Breast and Cervical Cancer Services Program

Revision 12-2; Effective June 1, 2012

Do not certify a person for a Medicare Savings Program if that person is receiving services through the Breast and Cervical Cancer Services (BCCS) program.

To receive services through the BCCS program, a person must be uninsured. As a result, insurance coverage from another Medicaid program or Medicare would stop that person from receiving services through the BCCS program.

The MSP EDG will be pended until MBCC denial is disposed by the TW advisor. The TW advisor will be notified of the pended MSP EDG by an Alert.

Q-4220 Reserved for Future Use

Revision 12-2; Effective June 1, 2012

 

Q-4230 Reserved for Future Use

Revision 12-2; Effective June 1, 2012

 

Q-4240 Reserved for Future Use

Revision 12-2; Effective June 1, 2012

 

Q-4250 Reserved for Future Use

Revision 12-2; Effective June 1, 2012