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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 14, 2023 Replacing August 29, 2022 Page 2 of H-3800 Revised/added text indicated by underscore Deleted text indicated by “” • The effective date of medical certification.

The LGE assesses the Act 421-CMO beneficiary annually to determine that the level of care requirement continues to be met.

H-3810.3 Special Income Level (SIL)

Income eligibility is based on the applicant/beneficiary's gross income. Gross income is compared to the SIL rate. The SIL rate is three times the Supplemental Security Income (SSI) Federal Benefit Rate (FBR) for an individual. Refer to Z-700 SIL Rate, Resource Limits & Personal Care Needs Allowance.

H-3820 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-3820.1 Determine Assistance/Benefit Unit

The assistance/benefit unit consists of the applicant/beneficiary. Each applicant/beneficiary must meet all eligibility requirements.

H-3820.2 Establish Categorical Requirement

Establish that the applicant/beneficiary:

• Is under the age of 19; • Meets the level of care provided in a hospital, skilled nursing facility or intermediate care facility, but lives at home; and • Has a physical or mental impairment, or a combination of conditions, that is disabling under the Social Security Administration listing of impairments; Note: Disability determinations must be made by the Medicaid Eligibility Determination team (MEDT) unless disability has been established by SSA. Refer to G-1600 Securing