Page 2
Louisiana Medicaid Eligibility Manual Eligibility Determinations
Reissued July 31,2024
Page 2 of H-1050 Replacing November 06, 2023
Revised/added text indicated by underscore
Deleted text indicated by “**”
When the projected waiver rate and incurred medical expenses are not sufficient to spend-down the applicant/beneficiary’s excess income to zero, eligibility is not established for the budget period. Continue the income eligibility process to determine if the applicant/beneficiary meets spend-down in the following budget period.
Example: The applicant is medically approved for the Community Choices Waiver Program on July 15th. The applicant’s gross monthly income is $3,062.00. After deducting the $20 SSI disregard and the $92 monthly MNIES, the applicant’s excess income is $2,950.00. The individual’s monthly Medicare premium is $109.00. The prorated projected waiver rate for July 15th to the end of the month is $2,794.46 ($5,000.00 average projected monthly rate x 12 months ÷ 365 days = $164.38 projected daily rate x 17 days = $2,794.46). The applicant has no other incurred medical expense deductions. After deducting the allowable incurred expenses, the applicant’s excess income does not spend-down to zero and is income ineligible for the budget period. **
$3,062.00 Gross monthly income
- 20.00 SSI standard deduction
$3,042.00
- 92.00 Rural monthly MNIES for 1
$2,950.00 Excess Income to spend-down
$2,950.00
- 109.00 Medicare premium
$2,841.00
- 2,794.46 Prorated waiver rate 46.54 Remaining Income
The application should be held for the next month to determine if the applicant will spend-down using for a full month of incurred expenses.
Individuals certified under the Spend-down MNP HCBS Program may be eligible for payment of HCBS waiver services (vendor payment). No payment is authorized to the waiver provider if the post eligibility determination results in a patient liability that exceeds the projected waiver rate.
Determine eligibility by applying the following criteria. The elements have been listed in the most logical order, but work on all steps