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Louisiana Medicaid Eligibility Manual Application Processing

Issued January 7, 2026 Replaced July 16, 2024 Page 9 of G-0000 Revised/added text indicated by underscore Deleted text indicated by “**”

G-810 APPLICANT UNABLE TO PARTICIPATE IN THE ELIGIBILITY DETERMINATION PROCESS If the applicant has been determined by court order to be physically incapable or mentally unable to complete the application form and has no one to act on their behalf, complete the form with information received from:  The parent, spouse, curator, or legal guardian (a person legally responsible for the care and management of the person or property of an individual considered by law to be incompetent to manage his own affairs); or  The responsible person (a person trusted or depended upon to assist in the care and management of the person or property of an individual, who has not been declared incompetent to manage his/her own affairs); Note: If the responsible person refuses or fails to cooperate, assist the applicant in designating another responsible person.  A different friend or relative;  Any other person with information about the applicant's situation who is designated to act as an authorized representative; or  By the agency representative's verification and documentation. Note: If the applicant is unable to participate in the eligibility process, or when the LTC responsible person fails to keep appointments or provide requested information, it becomes the agency representative's responsibility to assist the applicant in completing the application process. When the applicant is unable to participate, obtain and document supervisory approval when assuming this responsibility.

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Page 9

Official source

Louisiana Medicaid Eligibility Manual Application Processing

Issued January 7, 2026 Replaced July 16, 2024 Page 9 of G-0000 Revised/added text indicated by underscore Deleted text indicated by “**”

G-810 APPLICANT UNABLE TO PARTICIPATE IN THE ELIGIBILITY DETERMINATION PROCESS If the applicant has been determined by court order to be physically incapable or mentally unable to complete the application form and has no one to act on their behalf, complete the form with information received from:  The parent, spouse, curator, or legal guardian (a person legally responsible for the care and management of the person or property of an individual considered by law to be incompetent to manage his own affairs); or  The responsible person (a person trusted or depended upon to assist in the care and management of the person or property of an individual, who has not been declared incompetent to manage his/her own affairs); Note: If the responsible person refuses or fails to cooperate, assist the applicant in designating another responsible person.  A different friend or relative;  Any other person with information about the applicant's situation who is designated to act as an authorized representative; or  By the agency representative's verification and documentation. Note: If the applicant is unable to participate in the eligibility process, or when the LTC responsible person fails to keep appointments or provide requested information, it becomes the agency representative's responsibility to assist the applicant in completing the application process. When the applicant is unable to participate, obtain and document supervisory approval when assuming this responsibility.