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Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 8 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

Medicaid facility rate.

Example #1 The individual is in the facility as of May 1. The gross monthly income was $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 Medicare premium is $171.10. The projected monthly Medicaid facility rate is $3,906.11 ($128.42/day x 365 ÷ 12).

The projected monthly Medicaid facility rate and Medicare premium are not sufficient to spend-down the excess income. Eligibility is not established for LTC SD MNP However –

The daily private rate is $135.00. After remaining in the institution for three (3) days the individual has actually incurred charges of $405.00 at the private rate ($135.00 X 3). The projected Medicaid facility rate for the remaining 28 days in the month is $3,595.76 ($128.42 x 28 days). Thus as of the 4th day of the month the private payment charges of $405.00 and the projected Medicaid facility rate of $3,595.76 are sufficient to spend-down the excess income. Eligibility is established for LTC SD MNP/Income over Facility Fee effective the 4th day of the month through the end of the month (open/close certification).

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

$4,171.10 - 171.10 Medicare premium $4,000.00

- 3,906.11 Projected Medicaid facility rate $ 93.89 Spend-down not met for LTC SD MNP

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

$4,283.10 Gross monthly income