Page 2

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued August 11, 2023

Page 2 of H-3030 Replacing March 3, 2021 Revised/added text indicated by underscore

Deleted text indicated by “**” eligibility groups for individuals under age 19 into one coverage group. The Children Under Age 19 Group includes those children covered under LaCHIP. Eligibility for applicants/beneficiaries in the Children Under Age 19 Group is determined by using Modified Adjusted Gross Income (MAGI) methodology

A LaCHIP child is a child who:

• Is under the age of 19;

• Is not eligible for Medicaid under any other optional or mandatory eligibility group or eligible as medically needy (without spend-down liability).

• Does not have health insurance;

• Has MAGI-based income at or below 217 percent of the Federal Poverty Level (212 percent FPL plus 5 percent disregard).

Note:

Children certified in Category/Type Case 03-07:

• Ages 6-18 years old, and • MAGI income between 108 percent and 147 percent FPL, and • Do not have other health insurance

The state is allowed to collect enhanced funding for this group.

H-3032 ELIGIBILITY DETERMINATION PROCESS

Determine eligibility by applying the following criteria. The elements have been listed in the most logical order, but work on all steps simultaneously.

H-3032.1 Determine Assistance Unit

The assistance unit consists of the child(ren) under age 19.

H-3032.2 Establish Categorical Requirement

Verification must be provided that each child is under age 19.