Page 6

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued December 9, 2024

Page 6 of H-1100 Replacing February 6, 2023

Revised/added text indicated by underscore

Deleted text indicated by “”

Step 8. Combine the remainders in Step 3 and Step 7.

Step 9. Compare the total countable income to 100 percent FPL for two persons. Refer to Z-200 Federal Poverty Income Guidelines.

If the income is greater than the QMB income limit for two persons, the applicant/beneficiary is not eligible.

If the income is equal to or less than the QMB income limit for two persons, the applicant/beneficiary is income eligible.

Exception: Couples in a nursing facility or receiving waiver services who are being considered as individuals, are considered individuals for QMB need/countable income determinations. Refer to MEM 831.4.

If one spouse is in a nursing facility or receiving waiver services and his community spouse is not receiving waiver services, determine eligibility for each spouse as an individual. Consider income of each individual for separate QMB decisions. Note: Count as unearned income to the community spouse any income allocated from an institutionalized spouse.

H-1121.5 Eligibility Decision

Evaluate all eligibility requirements and verifications received to make eligibility decision.

H-1121.6 Certification Period

Eligibility for QMB shall not be retroactive from the application date.

The certification period shall not exceed 12 months.

QMB certifications are effective the month following the month the individual is determined to be QMB-eligible. The “month the individual is determined to be QMB-eligible” is the month that the individual is determined to meet all the requirements for QMB eligibility.

Example: