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Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 10 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

$4,000.00 -1,926.30 Prorated Medicaid facility rate for 15 days $2,073.70 Spend-down not met in LTC SD MNP

Continue eligibility review for LTC SD MNP/Income over Facility Fee

$4,171.10 Excess income - 171.10 Medicare premium $4,000.00 -2,025.00 Private payment charges for 15 days $1,975.00 Spend-down not met in LTC SD MNP/Income over Facility Fee

Example #3: The individual is in a facility on Medicare coinsurance and has income over the SIL. Coinsurance ends January 3rd and the individual converts to Medicaid only. The gross monthly income is $4,600.40. After the deducting the $20.00 standard deduction and the MNIES ($92.00 rural parish), the individual’s excess income or spend- down amount is $4,488.40.

The monthly Medicare premium is $171.10. The bill for Medicare coinsurance incurred for 2 days is $389.00 ($194.50/day x 2). The prorated projected Medicaid facility rate for January is $3,724.18 ($128.42/day X 29). The incurred coinsurance charges, the Medicare premium, and the projected Medicaid facility rate are not sufficient to meet spend-down in LTC SD MNP.

The prorated private payment rate for January is $3,780.00 ($135.00/day X 28). The incurred coinsurance charges, Medicare premium and the prorated private rate are not sufficient to meet the spend-down in LTC SD MNP/Income over Facility Fee.

$4,600.40 Gross monthly income - 20.00 Standard Deduction $4,580.40 - 92.00 MNIES for 1 person $4,488.40 Spend-down amount (excess income)

$4,488.40 - 171.10 Medicare premium