Page 3

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued December 9, 2024

Page 3 of H-1100 Replacing February 6, 2023

Revised/added text indicated by underscore

Deleted text indicated by “”

H-1121 ELIGIBILITY DETERMINATION PROCESS

Determine eligibility by applying the following criteria. The elements have been listed in the most logical order, but work on all steps simultaneously.

H-1121.1 Determine Assistance Unit

The assistance unit includes the applicant(s)/beneficiary(s).

H-1121.2 Establish Categorical Requirement

Verify entitlement/enrollment in Medicare Part A for the applicant/beneficiary. Medicare Part A eligibility, the start date for Medicare Part A, and the Medicare claim number may be verified through the interfaces available in LaMEDS. H-1121.3 Establish Non-Financial Eligibility

Verify eligibility for each member of the assistance unit with regard to the following factors: • Assignment of Third Party Rights I-200 • Citizenship/Identity and Qualified Non-Citizen Status I-300 • Enumeration

I-600 • Residence

I-1900

H-1121.4 Establish Need

A. Determine Composition of the Income Unit

The income unit includes the: • Applicant/beneficiary; • Applicant/beneficiary and ineligible spouse living in the same home; or • Applicants/beneficiaries who are a couple living in the same home (eligible couple). Note: If SSA considers the applicant/beneficiary and their spouse as a couple for SSI, they are considered as an eligible couple for the purposes of budgeting in the Medicare