Page 2

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 20, 2023

Page 2 of H-3200 Replacing September 6, 2016 Revised/added text indicated by underscore Deleted text indicated by “**”

H-3230 COVERED SERVICES

HPE beneficiaries receive the same benefits as those provided under the Medicaid group for which they are determined presumptively eligible. For example, an individual who is found presumptively eligible for Take Charge Plus will receive services limited to Take Charge Plus services and supplies.

Exception: HPE coverage for pregnant women is limited to ambulatory (outpatient) prenatal services including medically necessary transportation. Pregnant women are limited to one HPE period per pregnancy.

H-3240 HPE DETERMINATION PROCESS

HPE shall only be determined by a HPEQE by completing and submitting the BHSF Form 1-HPE. Louisiana Medicaid shall not make HPE determinations; however, program staff shall enter the HPE certification in the Louisiana Medicaid Eligibility Determination System (LaMEDS).

The agency shall not change an HPE determination made by a HPEQE, even if the determination was incorrect.

Exception: If the beneficiary has received HPE in the past twelve (12) months, or in the case of pregnant women, if the beneficiary has received HPE for the current pregnancy, the HPE certification shall be denied.

H-3240.1 HPE CERTIFICATION LIMITS

HPE certifications shall be limited to no more than one per twelve (12) month period for all coverage groups, with the exception of pregnant women, who are limited to one period of coverage per pregnancy.

H-3240.2 HPE CERTIFICATION PERIOD

The HPE certification period: • Begins on the date that the HPEQE determines eligibility; • Is never retroactive;