Page 2

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued July 22, 2020

Page 2 of H-1200 Replacing May 22, 2020

Deleted text indicated by “**” Revised/added text indicated by underscore

● Continue to have a disabling physical or mental impairment;

● Have lost premium-free Medicare part A due to Substantial Gainful Activity (SGA); and

● Not otherwise be eligible for Medicaid.

Individuals that have at least 30 quarters of coverage are eligible for a reduction in the Medicare part A premium and meet all of the above requirements are eligible for QDWI.

H-1210.1 Coverage

Coverage is limited to the payment of the Medicare Part A premium.

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

H-1221 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-1221.1 Determine Assistance/Benefit Unit

The assistance unit consists of the applicant(s)/enrollee(s).

H-1221.2 Establish Categorical Requirement

Verify that the applicant is enrolled, or conditionally enrolled, in Medicare Part A and is considered a QDWI. 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.