Page 11

Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 11 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

$4,317.30 - 389.00 Medicare coinsurance charges for 2 days $3,928.30 - 3,724.18 Prorated Medicaid facility rate for 29 days $ 204.12 Spend-down not met in LTC SD MNP

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

$4,488.40 Spend-down amount (excess income) - 171.10 Medicare premium $4,317.30 Excess Income

- 389.00 Incurred coinsurance charges $3,928.30 -3,915.00 Prorated private pay rate for 29 days $ 13.30 Spend-down not met in LTC SD

MNP/Income over Facility Fee

Example #4: The individual entered the facility January 17th. The gross monthly income is $4,283.10. After deducting the $20.00 standard deduction and the MNIES ($92.00 rural parish), the individual’s excess income or spend-down amount is $4,171.10. The monthly Medicare premium is $171.10. They also have incurred a dental bill on January 13th. The prorated Medicaid facility rate for 15 days is $1,926.30 ($128.42 X 15). The prorated Medicaid facility rate and Medicare premium are not sufficient to spend-down the excess income. Eligibility is not established for January in LTC SD MNP.

The prorated private payment rate for 15 days is $2,025.00 ($135.00 X 15). The private payment rate and Medicare premium are not sufficient to meet the spend- down. Eligibility is established for January in LTC SD MNP/Income over Facility Fee:

$4,283.10 Gross monthly income - 20.00 Standard Deduction $4,263.10 - 92.00 MNIES for 1 person $4,171.10 Spend-down amount (excess income)

$4,171.10 Excess income - 171.10 Medicare premium