Page 3

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 01, 2024

Page 3 of H-1000 Replacing February 2, 2017 Revised/added text indicated by underscore

Deleted text indicated by “**”

Note: HCBS Spend-down Medically Needy is limited to the Adult Day Health Care (ADHC), Community Choices (CC), New Opportunities (NOW), and Residential Options (ROW) waivers.

H-1011.1 Regular MNP

Individuals or families who meet the MAGI-related categorical requirements and have income at or below the monthly MNIES are certified for Regular MNP. Refer to H-1020, C-related MNP.

Note: The Parents/Caretaker Relative Program has a higher income limit than Regular MNP.

H-1011.2 Spend-down MNP

After completing the MAGI-related MNP or Non-MAGI related budget and excess income remains, deduct the allowable medical bills (refer to H-1011.5) incurred by the income unit to spend-down (reduce) the excess income to zero. Medical bills are deducted in chronological order (date order) based on the date of service).

Verify the applicant/beneficiary is liable for payment of the allowable bills used in the spend-down. If the allowable medical bills reduce the excess income to zero in the eligibility/budget period and all other eligibility factors are met, income eligibility is established. Eligibility for Medicaid begins on the date the excess income is spent down. If there is no Medicaid liability in the month the excess income is spent down, eligibility will begin on the first day of the month following the spend-down date in which there is a Medicaid liability or the first day of the month of the requested period of coverage whichever is earlier.

Note: The applicant cannot choose to exclude a month of eligibility coverage in which there is a Medicaid payable expense.

H-1011.3 Eligibility/Budget Period

Non-institutionalized The eligibility/budget period for non-institutionalized individuals is based on quarters (three (3) consecutive calendar months equal one