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Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 6 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

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individual is not eligible for LTC SD MNP. Determine eligibility for Spend-Down Medically Needy after coinsurance charges are incurred.

For the month the individual converts from Medicare coinsurance to Medicaid only, review eligibility for LTC SD MNP. Incurred coinsurance charges and the prorated projected Medicaid facility rate for the remainder of the month should be used to spend-down excess income.

Step 12. Subtract allowable paid and unpaid bills in chronological order oldest to most recent.

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Step 13. Subtract the current monthly Medicaid facility rate. To determine the monthly Medicaid facility rate, multiply the daily rate for the facility by 365 days and divide by 12 months. This amount is used for a full month.

Note: For month of admission the facility rate must be prorated using the number of days an individual is in the facility in the month of entry, if the applicant is not admitted on the first day of the month.

Example #1: Individual admitted on the 28th of the month. The prorated expense for the partial month is determined by multiplying the daily Medicaid facility rate by the number of days remaining in month including the date of admission.

Example #2: The individual was in a facility on Medicare coinsurance. His coinsurance ended January 17th. The gross monthly income was $4,349.10. After deducting the $20.00 standard deduction and the MNIES ($92.00 rural parish), the individual’s excess income or spend- down amount is $4,237.10. The Medicare premium is $171.10. The incurred coinsurance charges for 17 days is $2,337.50 ($137.50/day x 17 days). The projected prorated Medicaid facility rate for 14 days is $1,797.88 ($128.42/day x 14 days). The incurred medical