Page 7

Louisiana Medicaid Eligibility Manual Eligibility Determinations

September 15, 2023 Page 7 of H-1030 Replacing January 30, 2012

Revised/added text indicated by underscore

Deleted text indicated by “**”

month of the requested period of coverage whichever is earlier.

H-1031.5 Eligibility Decision

Evaluate all eligibility requirements and verification received to make an eligibility decision to either reject or certify the application. Review eligibility after each month the applicant is on Long Term Care Co- Insurance Spend-down for the previous month, and the first month after Co-Insurance ends for Long Term Care Spend-down eligibility.

H-1031.6 Certification Period

A Spend-down MNP certification is automatically closed at the end of each quarter of eligibility. For institutionalized persons, eligibility is to be reviewed for each month they are on co-insurance as a one month certification.

H-1031.7 Notice of Decision

Send the appropriate notice of decision to the applicant.

H-1031.8 Form 110-MNP

BHSF Form 110-MNP shall be completed on every Spend-down MNP certification. Each provider who rendered medical services on the spend down date is sent a copy of the Form 110-MNP.

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Page 7

Official source

Louisiana Medicaid Eligibility Manual Eligibility Determinations

September 15, 2023 Page 7 of H-1030 Replacing January 30, 2012

Revised/added text indicated by underscore

Deleted text indicated by “**”

month of the requested period of coverage whichever is earlier.

H-1031.5 Eligibility Decision

Evaluate all eligibility requirements and verification received to make an eligibility decision to either reject or certify the application. Review eligibility after each month the applicant is on Long Term Care Co- Insurance Spend-down for the previous month, and the first month after Co-Insurance ends for Long Term Care Spend-down eligibility.

H-1031.6 Certification Period

A Spend-down MNP certification is automatically closed at the end of each quarter of eligibility. For institutionalized persons, eligibility is to be reviewed for each month they are on co-insurance as a one month certification.

H-1031.7 Notice of Decision

Send the appropriate notice of decision to the applicant.

H-1031.8 Form 110-MNP

BHSF Form 110-MNP shall be completed on every Spend-down MNP certification. Each provider who rendered medical services on the spend down date is sent a copy of the Form 110-MNP.

**