Page 6

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued September 23, 2024 Page 6 of H-3600 Replacing October 17, 2022 Revised/added text indicated by underscore Deleted text indicated by “**” income greater than the SIL, consider eligibility as a couple.

If need is considered for the applicants/beneficiaries as a couple, use the couple SIL.

If the combined total gross income of the couple is equal to or less than the couple SIL, the applicants/beneficiaries are income eligible. Continue the determination of need using the couple resource limit.

If the combined gross income of the couple exceeds the couple SIL, the couple is income ineligible. Re-evaluate the eligibility of each member as an individual using the individual’s income and comparing it to the individual SIL.

If need is considered for the applicants/beneficiaries as a couple, consider eligibility for Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) using the couple QMB or SLMB standard.

C. Determine Composition of the Resource Unit

The resource unit consists of:

• The applicant/beneficiary;

• The applicant/beneficiary and the legal spouse living in the home; or

• Applicants/beneficiaries who are a couple (legally married) and both enrolled in PACE.

D. Determine Countable Resources

Determine total countable resources of the applicant/beneficiary. Refer to I-1630, Need - SSI-Related Resources.

If the individual’s home equity exceeds the limit, the individual will be totally ineligible for PACE. However, eligibility should be considered in other non-waiver programs.

If the applicant/beneficiary enrolled in PACE has a legal spouse living in the home, refer to I-1660 Spousal Impoverishment Resource Provisions (LTC/HCBS).