Page 6

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 01, 2024

Page 6 of H-1000 Replacing February 2, 2017 Revised/added text indicated by underscore

Deleted text indicated by “**” have the service included in the applicant/beneficiary’s treatment plan. If a copy of the treatment plan is not available, a letter from the physician indicating the need for the service may be used. An example of this service would be an attendant in the home who is not legally responsible for the care of the individual and who is providing personal care needs to an applicant/beneficiary.

• Allow bills for Medicaid covered medical services which are provided without charge (free care) to the applicant when services are delivered by a Medicaid-qualified provider and no third party will be charged for the medical services. (Federal financial participation (FFP) is available for Medicaid payments for care provided to individuals without charge.)

• Allow only the portion of the medical expense that is not covered or paid by a third party such as copays, coinsurance, or deductibles.

• Allow unpaid bills for medical services received not more than three (3) months prior to the month of application in chronological order from the oldest to the most recent.

If an applicant has been determined eligible for a budget period, any allowable bills that are not Medicaid payable (dental bills hearing aids, eyeglasses for a person 21 and over) and were not used in the spend-down for that budget period may be carried forward and used in the spend-down for the next budget period. As long as the applicant continues to be eligible in each subsequent budget period, allowable bills not previously used can be carried forward for use in the next budget period.

If the applicant becomes ineligible for a budget period and a break in coverage of at least one (1) month occurs, previous bills cannot be carried forward. The applicant will need to reapply and submit new bills.

• Allow current payments made on medical bills that were incurred prior to the spend-down period if the bills have not been used in a previous spend-down. A current payment is a payment made within the spend-down period.

Note: Treat unpaid loans and credit card charges which were used to pay