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Louisiana Medicaid Eligibility Manual Application Processing

Issued January 7, 2026 Replaced July 16, 2024 Page 24 of G-0000 Revised/added text indicated by underscore Deleted text indicated by “**”

the SSA denial, reject the application or initiate closure action if the case was certified based on the MEDT Consultant approval. Refer to L-0000 Changes. Exception: Submit or re-submit a MEDT packet for MPP disability determination if the applicant/beneficiary is employed.

G-1610.12 SSI APPEALS Pending Application Disability-Related Medicaid Request an MEDT decision if SSA has denied the application based on disability in the last twelve (12) months and the applicant provides documentation that the SSA determination has been timely appealed. Submit or re-submit an MEDT packet for program type MPP disability determination if the applicant/beneficiary is employed. Certified Disability-Related Medicaid Case If an individual receiving Medicaid based upon disability is determined by SSA not to be disabled under the SSI standard and the individual provides documentation that the SSA determination has been timely appealed, continue Medicaid coverage when all other eligibility factors are met until the final determination of disability has been made by SSA. Review available interfaces or contact the local SSA office requesting notice of appeal decision.

Follow-up with SSA is required every ninety (90) days.

G-1610.13 SIGNIFICANT DETERIORATION IN MEDICAL CONDITION AFTER SSA DENIAL If the applicant has been denied based on disability within the twelve (12) months prior to the Medicaid application, reject the Medicaid application unless:  An SSI appeal is in progress and the applicant’s income is above the Federal Benefit Rate (FBR);  A significant deterioration in medical condition can be documented;  A new medical condition can be documented; or  The applicant is employed and is applying for MPP coverage.