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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued December 9, 2024

Page 1 of H-1100 Replacing February 6, 2023

Revised/added text indicated by underscore

Deleted text indicated by “”

H-1100 QUALIFIED MEDICARE BENEFICIARY (QMB)

H-1110 GENERAL INFORMATION

Effective January 1, 1988, the Medicare Catastrophic Coverage Act of 1988 required expansion of Medicaid coverage for a mandatory eligibility group of low-income Medicare beneficiaries called Qualified Medicare Beneficiaries (QMB). The applicant/beneficiary must meet all of the following QMB requirements. A QMB must:

• Be entitled to or enrolled in hospital insurance benefits under Medicare Part A, but is not required to be enrolled in Medicare Part B. **

• Have income that is less than or equal to 100 percent of the Federal Poverty Income Guidelines (FPIG). Refer to Z-200 Federal Poverty Income Guidelines. Note: In January of each year, disregard the Social Security Administration (SSA) cost-of-living adjustment (COLA) through the month following the release of the annual FPIG update. For example, the annual FPIG is released in January, disregard COLA through February. Thereafter, determine eligibility using all income including the COLA for that year. • Meet all non-financial eligibility requirements for Medicaid.

H-1110.1 Coverage

QMB eligibles are divided into two categories:

QMB Only

Eligible for Medicaid payments for: • Medicare Part A (when applicable) and B premiums; • Medicare deductibles for Medicare covered services; and