Page 8

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 01, 2024

Page 8 of H-1000 Replacing February 2, 2017 Revised/added text indicated by underscore

Deleted text indicated by “**”

Applicants receiving services in hospitals operated by the LSU Healthcare system have separate physician bills for each hospital day.

1011.6 Medical Expenses Not Allowed in the Spend-down Process

• Do not allow unpaid bills for services incurred more than three (3) months prior to the month of application.

• Do not allow bills marked "free care" incurred more than three (3) months prior to the month of application.

• Do not allow bills for individuals not included in the MNIES.

• Do not allow bills, portions of bills, or current payments on bills that have previously been allowed in a spend-down.

• Do not allow bills for services incurred during a prior period of Medicaid coverage except for:

- Bills for services not covered by Medicaid;

- Bills not paid because the provider did not accept Medicaid assignment; and

- Bills for services provided after the applicant/beneficiary has exhausted his annual limitation of services, such as an adult exceeding twelve (12) visits per year.

• Do not allow paid bills for services incurred more than three (3) months prior to the month of application.

• Do not allow paid or unpaid bills for services incurred after the eligibility/budget period being considered.

• Do not allow bills for which the applicant is no longer liable.

• Do not allow bills for anticipated services such as a package of services which are paid prior to the date the services are rendered.

Exception: If a pre-paid package is itemized, services incurred and paid in the spend-down period can be allowed according to the schedule of the itemized bill.