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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued Feburary 06, 2023 Page 2 of H-1300 Replacing March 13, 2020 Revised/added text indicated by underscore Deleted text indicated by “**” • Eligible for the full range of Medicaid services under any other category of assistance. Individuals who qualify for one of the Medicare Savings Programs (QMB, SLMB, or QI) are automatically enrolled in SSA low-income subsidy (LIS program, also called Extra Help). This subsidy helps pay for the Medicare Part D prescription drug plan. For more information on the 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 SLMB, it is acceptable to use BHSF Form 1-A, Application for Health Care Coverage.

The eligibility determination is the same for both the SLMB Only and SLMB Plus.

A SLMB Plus beneficiary may continue to be eligible as a SLMB Only, when the full Medicaid case closes.

H-1321 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-1321.1 DETERMINE ASSISTANCE UNIT

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

H-1321.2 ESTABLISH CATEGORICAL REQUIREMENT

Verify 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-1321.3 ESTABLISH NON-FINANCIAL ELIGIBILITY

Verify eligibility for each member of the assistance unit with regard to