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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued April 14, 2022 Replacing July 1, 2014

Page 1 of H-3300 Revised/added text indicated by underscore

Deleted text indicated by “**”

H-3300 PROVISIONAL MEDICAID

H-3310 GENERAL INFORMATION

Effective February 9, 2014, for dates of service beginning February 1, 2014, Louisiana Medicaid implemented the Provisional Medicaid (PM) program for individuals with disabilities or age 65 and older. Coverage may not begin prior to February 1, 2014.

This program will provide Medicaid coverage to applicants/beneficiaries with income below the Federal Benefit Rate (FBR) and resources that meet SSI limits. A disability determination may be made by Medicaid’s Medical Eligibility Determination Team (MEDT) without first having an SSI determination made by the SSA.

Note: A decision by the MEDT is also required for applicants alleging blindness or a disability based on visual impairment. These applicants must be certified in the Disability “D” category and not in the Blind “B” category.

H-3320 DISABILITY DETERMINATIONS

An applicant who alleges a disabling condition shall have a disability determination made by MEDT when any of the following circumstances exist:

1. The applicant has applied for Medicaid and has not applied to SSA for SSI cash benefits.

2. The applicant has applied for Medicaid and SSI benefits and is found ineligible for SSI for a reason that does not apply to Medicaid (i.e. lawful permanent resident without 40 quarters of work history and other alien status, incarceration, resident of a state mental hospital/IMD, or transfer of assets).

3. The applicant has applied both for Medicaid and to SSA for SSI, and SSA has not made an SSI disability determination.

4. The applicant has applied for Medicaid and:

• claims a disabling condition different from, or in addition to,