Page 5

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued July 31,2024

Page 5 of H-1050 Replacing November 06, 2023

Revised/added text indicated by underscore

Deleted text indicated by “**” Refer to H-1011.5 Medical Expenses Allowed in the Spend-down Process and H-1011.6 Medical Expenses Not Allowed in the Spend-down Process.

Step 10. Subtract allowable incurred medical expenses.

Note: Only unpaid medical bills for services incurred within three (3) months prior to the application month may be used in the spend-down process. Refer to H-1011.5, Bills Allowed in the Spend-down Process.

Step 11. Subtract the projected waiver rate. Refer to Z- 2400.

Note: The projected waiver rate must be prorated when the applicant/beneficiary was not medically certified for the entire month.

Example: The applicant is medically certified for the Community Choices Waiver Program on April 15th. The applicant’s gross monthly income is $2,830.00. After subtracting the $20 standard deduction and $92 monthly MNIES from the gross monthly income, the applicant’s excess income is $2,718.00. The applicant’s Medicare premium is $109.00. The prorated projected waiver rate from April 15th to the end of the month is $2,630.08 ($5,000 average projected monthly rate x 12 months ÷ 365 days = $164.38 projected daily rate x 16 days). The applicant has no other incurred medical expenses deductions. The allowable incurred medical expenses are sufficient to meet spend-down.

$ 2,830.00 Gross monthly income

- 20.00 SSI standard deduction

$ 2,810.00

- 92.00 Rural monthly MNIES for 1

$ 2,718.00 Excess Income to spend-

down

$ 2,718.00