Page 2

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 4, 2021

Page 2 of H-3500 Replacing November 6, 2020 Revised/added text indicated by underscore

Deleted text indicated by “**”

• If a parent or other caretaker relative living with a dependent child under age 19, the child must have health coverage (Medicaid or private health coverage). H-3502.3 Establish Non-Financial Eligibility

Establish non-financial eligibility requirements in the Adult program. Verify eligibility with regard to the following factors: • Age – MAGI-Related I-100 • Assignment of Third Party Rights I-200 • Citizenship/Identity and Qualified Non-Citizen Status I-300 • Enumeration I-600 • Residence I-1900 If an applicant is applying for coverage for themselves and there is a child in the home, verify eligibility with regard to the following factor: • Support Enforcement Services (SES) I-2000

H-3502.4 Establish Need Household composition for the Adult Group is based on the MAGI methodology. Refer to I-1550 MAGI Determinations. Countable income for the Adult Group is based on the MAGI methodology. Refer to I-1550 MAGI Determinations. Compare to the income standard for the Adult Group. Refer to Z-200 Federal Poverty Guidelines. H-3502.5 Eligibility Decision Evaluate all eligibility requirements and verifications received to make the eligibility decision. H-3502.6 Certification Period The certification period may be effective no earlier than three (3)

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Page 2

Official source

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 4, 2021

Page 2 of H-3500 Replacing November 6, 2020 Revised/added text indicated by underscore

Deleted text indicated by “**”

• If a parent or other caretaker relative living with a dependent child under age 19, the child must have health coverage (Medicaid or private health coverage). H-3502.3 Establish Non-Financial Eligibility

Establish non-financial eligibility requirements in the Adult program. Verify eligibility with regard to the following factors: • Age – MAGI-Related I-100 • Assignment of Third Party Rights I-200 • Citizenship/Identity and Qualified Non-Citizen Status I-300 • Enumeration I-600 • Residence I-1900 If an applicant is applying for coverage for themselves and there is a child in the home, verify eligibility with regard to the following factor: • Support Enforcement Services (SES) I-2000

H-3502.4 Establish Need Household composition for the Adult Group is based on the MAGI methodology. Refer to I-1550 MAGI Determinations. Countable income for the Adult Group is based on the MAGI methodology. Refer to I-1550 MAGI Determinations. Compare to the income standard for the Adult Group. Refer to Z-200 Federal Poverty Guidelines. H-3502.5 Eligibility Decision Evaluate all eligibility requirements and verifications received to make the eligibility decision. H-3502.6 Certification Period The certification period may be effective no earlier than three (3)