Page 4

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 01, 2024

Page 4 of H-1000 Replacing February 2, 2017 Revised/added text indicated by underscore

Deleted text indicated by “**” (1) quarter) and is based upon the month of application.

Institutionalized The eligibility/budget period for institutionalized individuals is based on a one (1) month budget period.

The month of application must be one of the eligibility/budget months, unless the applicant requests retroactive eligibility to cover medical bills incurred three (3) months prior to the month of application.

An application form may be used for up to twelve (12) months unless there is a break in coverage.

Note: A break in coverage for MNP is defined as the beneficiary not being eligible for an entire month. One day of eligibility in the month is considered as being eligible for the entire month with no break in coverage.

The months of coverage shall not include previous Medicaid covered months, excluding Take Charge Plus, ** pure Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) or Qualified Individual (QI) certifications.

Example:

Spend-Down Eligibility Period The date of application is April. The applicant incurred medical expenses for services received in January, February, March and April. The medical expenses from January, February and March were used in the eligibility/budget. The excess income was reduced to zero with a March expense with a remaining liability on the expense. The eligibility period would be March, April and May.

Consecutive eligibility/budget periods If an individual requests further coverage and has bills for medical services which are not covered by Medicaid and the bills were not used in a previous eligibility determination, the medical bills may be carried forward and used in the subsequent eligibility/budget period.

Note: An individual who attained Medicaid eligibility through a spend- down while pregnant is eligible for the extended postpartum coverage even if the individual does not have sufficient incurred