Page 3

Louisiana Medicaid Eligibility Manual Issuing MECs and OSS Payments

Reissued July 21, 2025

Page 3 of J-0000 Replacing September 30, 2024 Revised/added text indicated by underscore

Deleted text indicated by “**”

or less, the applicant/beneficiary is not eligible for an OSS payment

This payment is not available to: ● Medicare SNF beneficiaries; ● Modified Adjusted Gross Income (MAGI)-based beneficiaries in an LTC facility; • Beneficiaries not eligible for vendor payment because of: - A transfer of resource penalty; or - Equity interest in the home exceeds the established limit; ● SSI recipients temporarily in a facility for up to three months who continue to receive full SSI benefits; or ● Beneficiaries of home and community-based services (HCBS). **

J-310 INITIAL OSS PAYMENTS

OSS payments are sent by electronic funds transfer (EFT) to the facility listed on the segment for the eligible beneficiary. LaMEDS sends a file to Gainwell Technologies for all beneficiaries eligible for payment each month on the night of cut off.

EFT payments are scheduled to be sent to the facilities the first full week of the month. Once the funds are received, the facility will disburse the funds to the beneficiaries eligible for an OSS payment.

LaMEDS initiates the OSS payments for current month and ongoing months. The amount of the payment is determined by the budget in LaMEDS.

If an individual’s certification is added to LaMEDS in the current month on or after cut off, the current month OSS payment must be considered a retroactive payment.

J-320 RETROACTIVE OSS PAYMENTS

Retroactive payments are issued electronically through the OSS system.

The Medicaid analyst completes the BHSF Form OSS-1 and submits