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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued December 9, 2024

Page 2 of H-1100 Replacing February 6, 2023

Revised/added text indicated by underscore

Deleted text indicated by “”

• Medicare coinsurance for Medicare covered services.

QMB Plus

Eligible for Medicaid payments for: • The same benefits listed for QMB Only; plus • The full range of Medicaid services.

Individuals who qualify for one of the Medicare Saving Programs (QMB, SLMB, or QI) are automatically enrolled in the SSA low- income subsidy (LIS) program (also called Extra Help). This subsidy helps pay for the Medicare Part D prescription drug plan premiums, co- payments, and the annual deductible. For more information on LIS/Extra Help, please visit the Social Security Administration Extra Help website.

Note: Although the BHSF Form 1-MB, Application for Medicare Savings Program, is commonly used to apply for QMB, it is acceptable to use BHSF Form 1-A, Application for Health Coverage.

SSI beneficiaries do not have to apply for QMB. Most Medicare- enrolled SSI recipients eligible for QMB must be automatically enrolled into QMB. If the SSI recipient who is entitled to enroll in Part A is not automatically enrolled, enter the QMB certification.

SSI recipients are deemed eligible for QMB the first month they are: • Eligible for Medicaid, and • Entitled to premium-free Part A and/or enrolled in Part B. The SSI recipients QMB eligibility coverage starts the first day of the month following the first month they are entitled to premium-free Part A and/or Part B. A beneficiary who is no longer eligible for full Medicaid may continue to be eligible as a QMB Only.

SSI/QMB Plus beneficiaries remain eligible for QMB after entering a long-term care (LTC) facility.