Page 9

Louisiana Medicaid Eligibility Manual Eligibility Determinations Reissued July 18, 2025 Page 9 of H-1040 Replacing July 31, 2024

Revised/added text indicated by underscore

Deleted text indicated by “**”

- 20.00 Standard deduction $4,263.10 - 92.00 Rural MNIES for 1 person $4,171.10 Spend-down amount

$4,171.10 - 171.10 Medicare premium $4,000.00 - 135.00 Daily private pay rate for Day 1 $3,865.00

- 135.00 Daily private pay rate for Day 2 $3,730.00 - 135.00 Daily private pay rate for Day 3 $3,595.00

- 3,595.76 Projected Medicaid facility rate for 28 days .00 Spend-down met on the 4th day of the

month in LTC SD MNP/Income over Facility

Fee.

Example #2: The individual entered the facility January 17th. The gross monthly income is $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 monthly Medicare premium is $171.10. The prorated Medicaid facility rate for 15 days is $1,926.30 ($128.42 X 15). The prorated Medicaid facility rate and Medicare premium are not sufficient to spend- down the excess income. Eligibility is not established for January in LTC SD MNP.

The prorated private payment rate for 15 days is $2,025.00 ($135.00 X 15). The private payment rate and Medicare premium are not sufficient to meet the spend- down. Eligibility is not established for January in LTC SD MNP/Income over Facility Fee:

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

$4,171.10 Excess income - 171.10 Medicare premium