Page 4

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued October 02, 2023

Page 4 of H-1020 Replacing June 3, 2021 Revised/added text indicated by underscore

Deleted text indicated by “**”

Spend-down MNP

Certification begins no earlier than the spend-down date and shall not exceed three months. This certification will be automatically closed. Refer to H-1011.3 Eligibility/Budget Period.

Note:

An individual who attained Medicaid eligibility through a spend-down while pregnant is eligible for the extended postpartum coverage even if the individual does not have sufficient incurred medical or remedial care expenses to meet their spenddown in any subsequent budget period during the pregnancy or extended postpartum period.

H-1021.7 Notice of Decision

Send the appropriate notice of decision to the applicant/beneficiary.

H-1021.8 Form 110-MNP

BHSF Form 110-MNP must be completed listing each provider who rendered medical services on the spend-down date. **

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Page 4

Official source

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued October 02, 2023

Page 4 of H-1020 Replacing June 3, 2021 Revised/added text indicated by underscore

Deleted text indicated by “**”

Spend-down MNP

Certification begins no earlier than the spend-down date and shall not exceed three months. This certification will be automatically closed. Refer to H-1011.3 Eligibility/Budget Period.

Note:

An individual who attained Medicaid eligibility through a spend-down while pregnant is eligible for the extended postpartum coverage even if the individual does not have sufficient incurred medical or remedial care expenses to meet their spenddown in any subsequent budget period during the pregnancy or extended postpartum period.

H-1021.7 Notice of Decision

Send the appropriate notice of decision to the applicant/beneficiary.

H-1021.8 Form 110-MNP

BHSF Form 110-MNP must be completed listing each provider who rendered medical services on the spend-down date. **