Page 3

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued October 02, 2023

Page 3 of H-1020 Replacing June 3, 2021 Revised/added text indicated by underscore

Deleted text indicated by “**” months) for which coverage is purchased.

Step 4. Subtract paid and unpaid bills including insurance co-payments and deductibles incurred for services received within the spend-down quarter in chronological order (per diem if necessary), oldest to most recent. Hospital bills shall be used before physician bills in the spend-down process.

On the date excess income is equal to the allowed medical expenses (“spent down”), the applicant is eligible for Spend-down MNP. This date is referred to as the spend-down date. Eligibility begins the date the excess income is spent down.

If there is no Medicaid liability in the month that the income is spent down, eligibility begins on the following date, whichever is earlier: • The first day of the month after the spend-down date, in which there is a Medicaid liability; or • The first day of the month of the requested period of coverage **.

Note: Refer to H-1011.4 Limited Certifications for Non- Institutionalized Individuals for limited one or two month certifications.

H-1021.5 Eligibility Decision

Regular MNP

Evaluate all eligibility requirements and verification received to make the eligibility decision.

Spend-down MNP

Evaluate all eligibility requirements and verification received to make the eligibility decision.

H-1021.6 Certification Period

Regular MNP

The certification period shall not exceed 6 months.