Page 3

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 4, 2021

Page 3 of H-3500 Replacing November 6, 2020 Revised/added text indicated by underscore

Deleted text indicated by “**” months prior to the application date, provided the individual is otherwise eligible. The months of retroactive coverage are not included in the twelve (12) month certification period. The twelve (12) month certification period begins with the month of application. Twelve months continuous eligibility does not apply to AG. Retroactive medical eligibility (RME) shall be explored for the three (3) months prior to the month of application. Refer to H-1800, Retroactive Medical Eligibility. ** H-3502.7 Notice of Decision Send the appropriate notice of decision to the applicant/enrollee.

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Page 3

Official source

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 4, 2021

Page 3 of H-3500 Replacing November 6, 2020 Revised/added text indicated by underscore

Deleted text indicated by “**” months prior to the application date, provided the individual is otherwise eligible. The months of retroactive coverage are not included in the twelve (12) month certification period. The twelve (12) month certification period begins with the month of application. Twelve months continuous eligibility does not apply to AG. Retroactive medical eligibility (RME) shall be explored for the three (3) months prior to the month of application. Refer to H-1800, Retroactive Medical Eligibility. ** H-3502.7 Notice of Decision Send the appropriate notice of decision to the applicant/enrollee.