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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 4, 2021

Page 1 of H-3500 Replacing November 6, 2020 Revised/added text indicated by underscore

Deleted text indicated by “**” H-3500 ADULT GROUP H-3501 GENERAL INFORMATION

The Affordable Care Act (ACA) of 2010 established a new optional Medicaid eligibility group for individuals age 19 through 64, hereafter referred to as the Adult Group (AG). Beginning July 1, 2016, this new group includes individuals with income less than or equal to 138 percent of the Federal Poverty Level (133 percent FPL, plus 5 percent disregard). Eligibility will be determined using Modified Adjusted Gross Income (MAGI) based income standards. H-3502 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-3502.1 Assistance Unit The assistance unit consists of the adult individual. H-3502.2 Establish Categorical Requirement Verify that the individual meets the following requirements: • Is age 19 or older, but under age 65; • Is not pregnant; Note: Enrollees who later become pregnant may remain in the Adult Group. • Is not entitled to or enrolled in Medicare Part A or Part B; Note: Applicants/enrollees with Medicare are not eligible for coverage, however, private insurance coverage is allowed.

• Is not otherwise eligible for Medicaid; and Reminder: If an individual is eligible for both the Former Foster Care (FFC) program and the optional AG program, enroll the individual in FFC.

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Page 1

Official source

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 4, 2021

Page 1 of H-3500 Replacing November 6, 2020 Revised/added text indicated by underscore

Deleted text indicated by “**” H-3500 ADULT GROUP H-3501 GENERAL INFORMATION

The Affordable Care Act (ACA) of 2010 established a new optional Medicaid eligibility group for individuals age 19 through 64, hereafter referred to as the Adult Group (AG). Beginning July 1, 2016, this new group includes individuals with income less than or equal to 138 percent of the Federal Poverty Level (133 percent FPL, plus 5 percent disregard). Eligibility will be determined using Modified Adjusted Gross Income (MAGI) based income standards. H-3502 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-3502.1 Assistance Unit The assistance unit consists of the adult individual. H-3502.2 Establish Categorical Requirement Verify that the individual meets the following requirements: • Is age 19 or older, but under age 65; • Is not pregnant; Note: Enrollees who later become pregnant may remain in the Adult Group. • Is not entitled to or enrolled in Medicare Part A or Part B; Note: Applicants/enrollees with Medicare are not eligible for coverage, however, private insurance coverage is allowed.

• Is not otherwise eligible for Medicaid; and Reminder: If an individual is eligible for both the Former Foster Care (FFC) program and the optional AG program, enroll the individual in FFC.