700.7 Medical Benefits for the SBP Recipient

Each SBP recipient gets an EBT ACCESS card to use for his medical assistance services.

55 Pa. Code § 451.3(k)

If an SBP recipient qualifies for both Medicare and Healthy Horizons, the CAO must tell the recipient that he can choose SBP benefits or Healthy Horizons benefits. The CAO must also explain that SBP benefits stop if he chooses Healthy Horizons benefits. The recipient must decide between the two programs. The CAO authorizes accordingly.

If an SBP recipient qualifies for Medicare and for Healthy Horizons Cost-Sharing benefits, the CAO must assign program status code 80 to the B category and enroll the client in Buy-In. See the Medical Assistance Eligibility Handbook, Chapter 319, Healthy Horizons.

NOTE:  SBP recipients qualify for Medicare Part D in addition to SBP medical benefits.

SBP recipients may not receive MAWD benefits in addition to SBP medical benefits.

If an SBP recipient also meets the requirements for Medically Needy Only (MNO) medical assistance, the CAO will authorize category TB.

A blind person who qualifies for SBP may receive payment for nursing home care in either a public or private nursing home. See the Long-Term Care Handbook.

55 Pa. Code § 451.3(j)

 

Reviewed July 30, 2013