Page 8

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued July 31,2024

Page 8 of H-1050 Replacing November 06, 2023

Revised/added text indicated by underscore

Deleted text indicated by “**” provider by the applicant/beneficiary or responsible party and shall be used to reduce the Medicaid payment to the provider. The waiver services provider will be responsible for collecting the patient liability.

**

The agency is responsible for informing the applicant/beneficiary of the monthly patient liability requirement for participation in the waiver before Medicaid is approved. The applicant/beneficiary must agree to pay the required PLI amount prior to certification.

If the applicant/beneficiary agrees to pay the required PLI amount, the certification is completed.

If the applicant/beneficiary does not agree to pay the patient liability amount, the application for HCBS will be rejected. Eligibility must be considered in all other non-waiver Medicaid programs.

H-1051.6 Certification Period

Certification for Spend-down MNP HCBS may not exceed 12 months.

Note: Although the instructions allow a 12-month certification period, a review of the budget must be completed at six (6) month intervals to determine if the client remains eligible. Enterprise Document Management System (EDMS) case record entries will document the case review.

Six (6) month review: Actual projected waiver expenses must be verified prior to establishing a new spend-down period. The projected waiver expenses must be reconciled with actual incurred expenses. The waiver expenses can be reconciled using the Medicaid Enterprise System (MES) files reflecting the amount billed by the provider(s).

H-1051.7 Notice of Decision

Send the appropriate Notice of Decision to the applicant/beneficiary, the provider and OAAS/OCDD.