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Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 13 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

If resources were transferred for less than FMV within the 60 month look back-period, and the transfer does not qualify for exception, a penalty period will be assessed. During the penalty period the applicant/beneficiary is ineligible for vendor payment. Consider eligibility for Medicaid benefits without vendor payment. Refer to I- 1670 Transfer of Assets for Less than Fair Market Value.

If the applicant/beneficiary’s equity interest exceeds the allowable home equity limit, consider eligibility for Medicaid benefits without vendor payment.

Compare total countable resources to the applicable resource limit. Refer to Z-900 Resource Limits by Program and Refer to Z-800 Spousal Impoverishment Resource Standard.

If resources are equal to or less than the applicable resource limit, the applicant/beneficiary is resource eligible. Continue the determination of need.

If resources are greater than the applicable resource limit, the applicant/beneficiary is resource ineligible.

H-1041.5 Determine Patient Liability – PLI **

Post-eligibility treatment of income (PETI) rules are used to calculate an applicant/beneficiary’s contribution to their cost of care for nursing home, Home and Community Based Waiver or ICF/IID services. Also called patient liability (PLI). PLI is the amount the applicant/beneficiary must pay towards their monthly cost of care. It is based on the amount of monthly income remaining after allowable deductions.

Refer to I-1538 Patient Liability (PLI) ** for the Patient Liability Calculation Process.

Exception: LTC SD MNP/Income over Facility Fee certifications have neither a Patient Liability (PLI) nor a segment.

H-1041.6 Certification Period

Certification for LTC SD MNP may not exceed twelve (12) months.

Note: Although the instructions allow a twelve (12) month certification