Page 2

Louisiana Medicaid Eligibility Manual

Eligibility Determinations

Issued July 20, 2020

Page 2 of H-3400 Replacing June 14, 2016

Deleted text indicated by “**” Revised/added text indicated by underscore

 Has not previously had a medical procedure that would prevent pregnancy, such as tubal ligation, hysterectomy or vasectomy.

H-3420 ELIGIBILITY DETERMINATION PROCESS Determine eligibility by applying the following criteria (beginning at H-3420.1). Elements have been listed in the most logical order, but work on all steps simultaneously.

H-3420.1 DETERMINE ASSISTANCE UNIT The assistance/benefit unit consists of the applicant/enrollee. H-3420.2 ESTABLISH NON-FINANCIAL ELIGIBILITY

Verify eligibility with regard to the following factors:  Assignment of Third Party Rights I-200  Citizenship/Alien Status I-300  Enumeration I-600  Residence I-1900  SES Referral I-2000

H-3420.3 ESTABLISH NEED Household composition and countable income for TCP is based on the Modified Adjusted Gross Income (MAGI) methodology. Refer to I-1550 MAGI Determinations.

Compare MAGI-based income to the TCP income standard. Refer to Z-200 Federal Poverty Income Guidelines.

H-3420.4 ELIGIBILITY DECISION Evaluate all eligibility requirements and verifications received to make the eligibility decision to either reject/close, certify, or extend eligibility.