Page 12

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews P a g e | 12 Effective Month: September 2023 • Specified Low-Income Medicare Beneficiaries (SLMB) must be entitled to Medicare Part A and have income greater than 100% of the federal poverty level but less than 120% of the federal poverty level. Medical assistance for this group is limited to payment of Medicare Part B or Medicare Part B-ID premiums. • Qualifying Individuals (QI) must be entitled to Medicare Part A and have income that is at least 120% of the federal poverty level but less than 135% of the federal poverty level. Medical assistance for this group is limited to payment of Medicare Part B or Medicare Part B-ID premiums under a federal allotment of funds. Eligibility for coverage as a QI is dependent on the availability of federal funds. • Payment of the Medicare Part D pharmacy plan premium is applicable to the Medicare cost-sharing groups of QMB, SLMB and QI provided the beneficiary enrolls in a benchmark or $0 premium pharmacy plan. Benchmark plans are subject to change each calendar year based on plans that choose to participate within Mississippi. • Qualified Disabled and Working Individuals must be entitled to Medicare Part A and have income that does not exceed 200% of the federal poverty level whose return-to-work results in the loss of coverage for Medicare. Medical assistance is limited to payment of the Part A premium. 101.02.03 MANDATORY CATEGORICALLY NEEDY – SPECIAL GROUPS

Mandatory Coverage of Certain Aliens for Emergency Services Emergency services, including labor and delivery services, must be provided to aliens who meet all eligibility requirements for Medicaid coverage in any MAGI- related or ABD coverage group except for their alien status who need treatment of an emergency medical condition. Transplant services are prohibited. Coverage is limited to treatment of the emergency condition only. The Division of Medicaid certifies Medicaid coverage for Emergency Services for Aliens. Mandatory Presumptive Eligibility Determined by Qualified Hospitals Qualified hospitals must be allowed to determine presumptive eligibility for individuals eligible for Medicaid in certain Medicaid coverage groups, referred to as Hospital Presumptive Eligibility or HPE. HPE allows qualified hospitals to