Page 7

Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 7 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

expenses and the prorated projected Medicaid facility rate are sufficient to meet spend-down.

$4,349.10 Gross monthly income - 20.00 Standard Deduction $4,329.10 - 92.00 Rural MNIES for 1 person $4,237.10 Spend-down amount (excess Income)

$4,237.10 -171.10 Medicare premium $4,066.00 -2,337.50 Coinsurance charges for 17 days $1,728.50 -1,797.88 Prorated Medicaid rate for 14 days .00 Spend-down met

If the remaining income is $0.00, the individual has spent down and is eligible for LTC SD MNP. Use LTC SD MNP when income is over the SIL and under the Medicaid Facility Rate. Proceed with the PLI determination. Refer to H-1041.5 Determine Patient Liability.

If excess income remains continue with section C below.

If there is no remaining excess income, proceed to Section D below.

C. Determination of Countable Income for Individuals with Income over the SIL and over the Medicaid Facility Rate.

Follow steps 1 through 11 above, then ** proceed to step 14 below.

Step 14. ** Subtract the current daily private payment rate and incurred medical expenses on a daily basis, in chronological order. The daily private payment rate continues to be deducted until the remaining excess income falls below the prorated balance of the Medicaid facility rate.

Note:

LTC SD MNP/Income over Facility Fee coverage begins on the day that the remaining excess income is less than or equal to the prorated balance of the