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Louisiana Medicaid Eligibility Manual Tuberculosis (TB) Infected

Issued May 16, 2022 Page 1 of H-1600 Replacing August 12, 2021

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

H-1600 TUBERCULOSIS (TB) INFECTED

H-1610 GENERAL INFORMATION

Section 13603 of the Omnibus Budget Reconciliation Act (OBRA) of 1993 allows States the option to provide Medicaid benefits to eligible **beneficiaries diagnosed as, or suspected of, being infected with Tuberculosis (TB). The effective date of the optional TB provisions program is August 1, 1995.

These beneficiaries are only eligible for TB-related services, not the full range of Medicaid covered services. Coverage is restricted to outpatient medical services directly related to the diagnosis, confirmation and treatment of TB, including physician, pharmacy, laboratory, X-ray, Rural Health Clinic, and Federally Qualified Health Center services. TB-infected beneficiaries are eligible for directly observed therapy services for TB treatment from the Office of Public Health (OPH). They are not eligible for coverage of inpatient hospital services, nursing facility services, or room and board.

An applicant/beneficiary diagnosed as, or suspected of, being infected with TB, may be eligible for Medicaid services under the TB-infected program if not otherwise eligible for Medicaid.

Eligibility for individuals with TB will be determined using Modified Adjusted Gross Income (MAGI)-based income standards. This group included individuals with income less than or equal to 160 percent of the Federal Poverty Level (FPL) (155 percent plus 5 percent disregard).

H-1620 ELIGIBILITY DETERMINATION PROCESS

Determine eligibility by applying the following criteria. The elements are listed in the most logical order, but all steps should be performed simultaneously.

H-1620.1 DETERMINE ASSISTANCE UNIT

The assistance unit consists of the applicant/beneficiary.