Page 7

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued April 14, 2022 Replacing July 1, 2014

Page 7 of H-3300 Revised/added text indicated by underscore

Deleted text indicated by “**” eligible for Provisional Medicaid.

H-3340.5 Eligibility Decision

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

H-3340.6 Certification Period

The certification period shall not exceed twelve months, not including any retroactive coverage. Retroactive medical eligibility shall be explored for the three months prior to the month of application. Refer to H-1800 Retroactive Medicaid Eligibility (RME).

NOTE: Applicants will be required to apply for any annuity, pension, retirement, and disability benefits (not including SSI) for which they are entitled to. A review is to be conducted every six months to determine the status of the beneficiary’s application for other benefits, if any. Confirmed receipt of other benefits must be evaluated to determine effect on eligibility.

H-3340.7 Notice of Decision

Send the notice of decision to the applicant/beneficiary.

H-3350 SOCIAL SECURITY ADMINSTRATION (SSA) DETERMINATIONS

SSI determinations take precedence over the MEDT determination. An SSI denial decision will require action to determine if it applies to Medicaid and if so, a review for eligibility in any other Medicaid program prior to taking action to close the Provisional Medicaid certification. Refer to G-1610.12 SSI Appeals, when the SSA decision has been appealed.