Page 5

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued September 23, 2024 Page 5 of H-3600 Replacing October 17, 2022 Revised/added text indicated by underscore Deleted text indicated by “**” and both enrolled in PACE.

Note: Never consider the income of the legal spouse and/or dependent(s) living in the home when determining eligibility for the PACE participant.

B. Determine Need/Income

Individual

Determine the gross income of the applicant. Refer to I-1530 Need - SSI-Related Income.

The applicant/beneficiary must be income eligible based on gross income.

Note: Exclude any income received from VA Aid and Attendance from the gross income computation.

Add the gross earned and unearned income. Compare the total income to the SIL. If the applicant/beneficiary is an individual, use the individual SIL. Refer to Z-700 LTC/HCBS SIL Rate, Resource Limits & Personal Care Needs Allowance.

If the total gross income of the applicant/beneficiary is greater than the SIL, the applicant/beneficiary is income ineligible.

If the total gross income is equal to or less than the SIL, the applicant/beneficiary is income eligible. Continue the determination of need.

Couples enrolled in PACE

Beginning with the month that both the applicant and legal spouse enroll in PACE, determine whether it is to their advantage to have need considered:

● As a couple; or ● As individuals. First, consider eligibility for each member of the couple as an individual. If one member of the couple has gross countable