Specified Medicare Beneficiary (SLMB) (S05)

Created on:

Nov 06 2019

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

The S05 medical is a Medicare Savings Program that pays Medicare Part B premiums for qualified clients. For more information on this program, see Apple Health eligibility manual - Apple Health Medicare Savings Programs & Medicare Buy-In Programs.

A person who meets the following criteria may be eligible for S05 Medical:

Is eligible for or receiving Medicare;
Has countable income greater than 100% but less than 120% of the Federal Poverty Level (FPL) and countable resources at or below the resource standards.

For more information, see:

Eligibility for S05 begins the first of the month the client becomes eligible for Part B coverage and is certified for 12 months. For more information, see Apple Health eligibility manual - WAC 182-504-0025 Medicare savings program certification periods.

The pending Qualified Medicare Beneficiary (S03) trickles to the Qualified Individual (S06) medical program when:

The client’s countable income is greater than 120% but less than 135% of the FPL,
Their countable resources are at or below the Medicare Savings Program Resource Limit found at https://www.hca.wa.gov/assets/free-or-low-cost/MSP-Eligibility-Chart.pdf and
The client is not receiving Categorically Needy (CN) or Medically Needy (MN) medical coverage.

Online Processing

An S05 Assistance Unit (AU) is initially screened in as a Qualified Medicare Beneficiary (S03) AU following the instructions in How do I screen Qualified Medicare Beneficiary (S03) medical?

Note: If eligible the S03 AU trickles to S05 when it is finalized

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.