Page 1
Louisiana Medicaid Eligibility Manual Eligibility Determinations
Reissued June 30, 2023
Page 1 of H-2000 Replacing February 28, 2020 Revised/added text indicated by underscore
Deleted text indicated by “**”
H-2000 QUALIFYING INDIVIDUALS PROGRAM
H-2010 GENERAL INFORMATION
Effective January 1, 1998, Section 4732 of the Balanced Budget Act of 1997 required states to pay the Medicare Part B premiums for a new mandatory eligibility group of low-income Medicare beneficiaries, called Qualifying Individuals (QI).
The applicant/beneficiary must meet all of the following QI requirements. A QI must:
• Be enrolled in hospital insurance benefits under Medicare Part A, but does not have to be currently enrolled in part B;
• Have income equal to or greater than 120 percent, but less than 135 percent of the Federal Poverty Income Guidelines (FPIG). Refer to Z-200 Federal Poverty Income Guidelines; and
Note: In January of each year, disregard the Social Security Administration (SSA) cost of living adjustment (COLA) through the month following the release of the FPIG update. Thereafter determine eligibility using all income including the COLA for the current year.
• Meet all non-financial eligibility requirements for Medicaid.
The months of coverage for Medically Needy Program (MNP) shall not include previous Medicaid-covered months, excluding pure Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or QI certifications. The only instance in which a person can be certified for both MNP and QI is for retroactive MNP coverage. Due to system limitations, overlaps in eligibility cannot be avoided and previous eligibility cannot be removed. Since federal regulations stipulate that a QI cannot be otherwise Medicaid eligible, any prospective overlaps in MNP/QI eligibility must be avoided.
An applicant/beneficiary who is eligible for QI can be certified in both the QI and Take Charge Plus (TCP) programs.
H-2010.1 Coverage
Eligible for Medicaid payment for the Medicare Part B premium.