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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued October 24, 2025 Page 4 of H-2300 Replacing April 21, 2025 Revised/added text indicated by underscore Deleted text indicated by “*” Above 250% – <= 300 Yes $15.00 Above 250% – <= 300% No $35.00

Federally recognized American Indians or Alaskan Natives do not pay a premium.

The premium is waived where requiring a payment would create an undue hardship. Undue hardship exists when a family: • Is homeless or displaced due to a flood, fire, or natural disaster, • Resides in an area where there is a Presidentially Declared Disaster in effect, • Has a current notice of eviction or foreclosure, or • Has a circumstance the Medicaid Director’s office determines meets the criteria.

The first month a premium applies is the month after the eligibility decision is made. Premiums will not be applied for coverage in any months prior to the month the eligibility decision is made (including retroactive Medicaid eligibility). See H-1800 Retroactive Medical Eligibility (RME).

H-2320.6 Eligibility Decision

Evaluate all eligibility requirements and verification received to make the eligibility decision to either reject, close, certify, or extend eligibility.

H-2320.7 Certification Period

Certification period shall not exceed 12 months from the month of

application.

H-2320.8 Notice of Decision

An eligibility notice of decision shall be sent to the applicant.