Page 5

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 01, 2024

Page 5 of H-1000 Replacing February 2, 2017 Revised/added text indicated by underscore

Deleted text indicated by “**” medical or remedial care expenses to meet their spenddown in any subsequent budget period during the pregnancy or extended postpartum period.

H-1011.4 Limited Certifications for Non-Institutionalized Individuals

It is necessary in some instances to consider less than a full quarter of coverage. When considering less than a full quarter, multiply the monthly MNIES times the number of eligible months.

Income above the MNIES is not a reason for limiting the certification.

Any of the following conditions are reasons to limit the eligibility period to less than three months:

• Death of an applicant;

• The applicant/beneficiary does not meet a non-financial eligibility or categorical requirement in one or two months of the quarter;

• Full Medicaid coverage under another program for part of the quarter;

• Excess resources (Non-MAGI-related group); or

• In an Emergency Medical Services (EMS) certification.

H-1011.5 Medical Expenses Allowed in the Spend-down Process

• Allow all bills for medical services for which the applicant is legally liable and are recognized as medically necessary under state law (e.g., psychiatric, dental, physical therapy services, medical equipment, and medical supplies).

Note: Medical services not covered or limited by Medicaid are allowed in the spend-down calculation. For example, dental care for individuals age 21 or older.

For purposes of the Medicaid Program, "medically necessary under state law" refers to any medical service required by an applicant as prescribed by a physician. The physician must