Page 7

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued September 23, 2024 Page 7 of H-3600 Replacing October 17, 2022 Revised/added text indicated by underscore Deleted text indicated by “**”

Compare total countable resources to the SSI resource limit for an individual (or couple). Refer to Z-900 Resource Limits by Program.

If resources are greater than the resource limit, the applicant/beneficiary is resource ineligible for PACE.

If resources are equal to or less than the resource limit, the applicant/beneficiary is resource eligible for PACE.

If the resources of a couple are greater than the couple resource limit, consider eligibility for each spouse as an individual.

H-3621.5 Eligibility Decision

Evaluate all eligibility requirements and verification received to make the eligibility decision.

Medicaid eligibility may begin on the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement.

Consider QMB or SLMB eligibility for all PACE applicants. Refer to H-1121, QMB Eligibility Determination Process or H-1321, SLMB Eligibility Determination Process.

H-3621.6 Certification Period

The certification period cannot exceed twelve months beginning with the first day of the first month of eligibility for the PACE program.

H-3621.7 Notice of Decision

Send the notice of decision to the applicant/beneficiary.

Send a copy of the decision notice to the PACE organization.

H-3621.8 Post Certification

Refer potentially eligible beneficiaries for SSI.