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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued October 24, 2025 Page 3 of H-2300 Replacing April 21, 2025 Revised/added text indicated by underscore Deleted text indicated by “*”

C. Determine Countable Income

Complete the following steps:

Step 1. Determine total gross earned and unearned income of the income unit.

Step 2. Subtract the FOA deduction of $85. This yields the countable income for premium determination. If eligible, at the end of all budget steps, this amount will be used to determine monthly premium amount due. (See H-2320.5 Determine Monthly Family Opportunity Act (FOA) Medicaid Buy-In Program Premium Amount)

Step 3. Subtract one-half of the remainder from Step 2.

Step 4. Compare the remaining monthly income to the comparable household size at 150 percent of the FPIG. If income is greater than the limit, the applicant/beneficiary is ineligible. If income is equal to or less than the limit, the applicant/beneficiary is eligible. H-2320.5 Determine Monthly Family Opportunity Act Medicaid Buy-In Program Premium Amount

Premiums for FOA are charged per family or income unit.

Subtract the $85 FOA deduction from the total gross earned and unearned income.

Compare the remainder to the MEM Z-2500 FPIG for Premium Programs.

Income units with income less than or equal to 200 percent FPIG will not have a premium.

A premium payment is required for income units with income above 200 percent and less than or equal to 250% FPIG according to the following:

Income Range (% FPIG) Legal/Natural Parents in Home have Creditable Health Insurance Monthly Premium Above 200% – <= 250% Yes $12.00 Above 200% – <= 250% No $30.00