Page 9

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 01, 2024

Page 9 of H-1000 Replacing February 2, 2017 Revised/added text indicated by underscore

Deleted text indicated by “**”

• Bills or the portion of bills which have been paid or will be paid by insurance, legal settlement, family member who is not in the income unit or assistance unit or any other third party resource.

Take reasonable measures to determine the legal liability of third parties to pay for incurred expenses.

Do not forestall an eligibility determination simply because third party liability cannot be ascertained or payment by the third party has not been received.

Medicare Eligibles

If after exhausting every reasonable effort to determine the exact liability determine the liability as:

- the deductible for Medicare Part A (inpatient); and

- the deductible plus 20 percent of the balance of the actual charges for Medicare Part B (outpatient).

Note: For hospital inpatient stays, Medicare eligibles are allowed only the deductible for Part A. Do not allow the additional 20 percent for actual hospital charges.

Non-Medicare Eligibles

If every reasonable effort to determine the exact amount of the liability has been exhausted, obtain an estimated amount from the insurance company to be used in the spend-down process.

H-1012 MAGI-RELATED MNP CARETAKER RELATIVE

To be considered for Parents and Caretaker Relatives MNP, the individual must:

• Be a parent, grandparent, sibling or step-sibling, brother or sister-in-law, step-parent, aunt, uncle, first cousin, niece or nephew, the legal spouse of parents or caretaker relatives;

• Assume primary responsibility of a dependent child under age