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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued September 23, 2024 Page 3 of H-3600 Replacing October 17, 2022 Revised/added text indicated by underscore Deleted text indicated by “**”

H-3610.4 Post-Eligibility Determination

Post-eligibility treatment of income rules do not apply.

PACE participants do not owe a patient liability while being cared for in the community.

When a PACE participant can no longer be cared for in the community, they may be placed in a nursing facility. As long as the participant resides in a nursing facility and remains enrolled in PACE, the PACE provider will continue to pay for all of their care.

H-3610.5 SSI Beneficiaries

SSI beneficiaries who enter PACE remain eligible for Medicaid if they continue to receive SSI payments while enrolled in PACE.

There are two circumstances under which payment to the PACE organization may be denied due to resource ineligibility for an individual who receives SSI and has been medically certified for PACE. They are:

• A Medicaid Qualifying Trust exists; or • An OBRA ’93 Trust exists.

Refer to I-1700 Trust to determine if the Trust is a countable resource to the SSI beneficiary.

Note:

Transfer of resources for less than FMV does not apply when

determining eligibility for PACE.

H-3620 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-3621.1 Determine Assistance/Benefit Unit

The assistance/benefit unit consists of the applicant/beneficiary.