Page 1

Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 1 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

H-1040 LONG TERM CARE SPEND-DOWN MEDICALLY NEEDY PROGRAM (LTC SD MNP) – SSI-RELATED

H-1041 ELIGIBILITY DETERMINATION PROCESS

A person who resides in a long-term care (LTC) facility who meets all other eligibility requirements, but has income over the Special Income Limit (SIL) may be eligible for LTC SD MNP. The person must incur medical expenses in an amount which is equal to or greater than their monthly excess income to meet spend-down. LTC SD MNP uses a one-month budget period.

Consider the projected cost for facility care as an incurred medical expense to meet spend-down. The projected monthly cost of care is determined by multiplying the daily Medicaid facility rate for the specific nursing home or ICF/IID in which the individual resides by 365 days and then dividing by 12 months. The projected Medicaid facility rate should be prorated if the individual was not in the facility for the entire month.

Other allowable incurred medical expenses, including Medicare and private health insurance premiums, deductibles, skilled nursing facility (SNF) coinsurance, copays, and medical/remedial care expenses that are not subject to payment by a third party, can be used to spend- down excess income. Verify the applicant’s liability for payment of the incurred medical expenses used in the LTC SD MNP budget. Refer to H-1011.5 Medical Expenses Allowed in the Spend-down Process.

Note: Eligibility for LTC SD MNP cannot be established for individuals receiving Medicare skilled nursing facility (SNF) services incurred during the current month. Determine eligibility after charges are incurred for the previous month(s). Eligibility is evaluated on a monthly basis.

When the individual’s excess income is spent down using the projected Medicaid facility rate and the other allowable incurred medical expenses (Medicare co insurance, hospital bills, etc.), Medicaid eligibility begins the first day of the budget month. Vendor payment begins the date of admission or the first day of the month the individual is determined eligible, if later.

When the projected Medicaid facility rate and the other allowable