Page 7
Louisiana Medicaid Eligibility Manual Eligibility Determinations
Issued March 01, 2024
Page 7 of H-1000 Replacing February 2, 2017 Revised/added text indicated by underscore
Deleted text indicated by “**” the medical provider as unpaid medical bills if they were not used previously. Verify the applicant’s current liability. Verify that the loans and credit card charges were actually used to pay medical bills.
• Allow bills for all persons included in the MNIES.
• Allow bills incurred by a deceased person who would have been included in the MNIES if another person included in the MNIES is legally responsible for the bills.
• Allow Medicare or other private health insurance premiums when payment is due. For example, if the individual's policy is based on an annual premium, the premium deduction cannot be used again until the premium payment is due for an additional twelve (12) month policy period. If individuals are included in the policy but are not included in the MNIES, allow only the pro-rata share for the individuals included in the MNIES.
• Allow current state mileage reimbursement for medical transportation.
• Allow incurred Medicare coinsurance charges that are not payable by a third party while on skilled nursing care. Medicare coinsurance charges cannot be projected for individuals in a long term care facility.
Bills used to spend-down excess income are the responsibility of the applicant/beneficiary. Bills used in a spend-down budget that establishes eligibility can only be used once. All bills must be applied in chronological order. If bills occur on the same date, use the following designated order:
1) Bills for services not payable or covered by Medicaid, such as a dental bill for someone who is 21 and over;
2) Hospital bills;
3) All remaining bills.
To determine the chronological order of hospital bills (state and private) that cannot be itemized, use the per diem for the daily charges. The per diem is determined by dividing the total number of days, excluding the discharge date, into the total bill.