Page 2

Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 2 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

incurred medical expenses (Medicare co insurance, hospital bills, etc.) are not sufficient to spend-down the individual’s excess income, continue the eligibility process to determine if individual could meet spend-down later in the month using LTC SD MNP/Income over Facility Fee.

For an LTC SD MNP/Income over Facility Fee budget use a combination of expenses actually incurred at the private payment facility rate and remaining expenses projected at the Medicaid facility rate to spend down excess income. Verify the nursing facility private pay rate and Medicaid facility rate used in the determination.

If eligibility is established, Medicaid eligibility begins the date the individual meets spend-down. Spend-down is met on the day that the remaining excess income is less than or equal to the projected Medicaid facility rate prorated for the remaining days of the month.

If eligibility is not established for the month of admission, the eligibility process should be continued to determine if individual could meet LTC SD MNP the next month using a full month of expenses. Incurred private payment charges incurred in the previous month may be used in spend-down if the bill remains unpaid.

Example: Individual entered the nursing facility on the 15th of a month. The prorated Projected Medicaid Facility rate does not spend-down the excess income for the month of entry. If using the actual private rate and Medicaid facility rate still does not spend-down the individual for the month of entry, the application should be held for the next full month to determine if the individual can spend down using a full month’s expenses.

Individuals certified under LTC SD MNP type cases may be eligible for vendor payment to the LTC Facility.

Note: No vendor payment is authorized to the LTC facility if the post- eligibility determination results in Patient Liability (PLI) that exceeds the Medicaid facility rate.

Exception: LTC SD MNP/Income over Facility Fee certifications are not eligible for vendor payment.