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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued February 3, 2026

Page 2 of H-3900

Revised/added text indicated by underscore

Deleted text indicated by “**”

H-3902 Coverage

The LaHIPP Program is a premium assistance program, not a separate Medicaid coverage group. Participation in LaHIPP does not establish Medicaid, affect eligibility, or provide independent Medicaid coverage and is not considered creditable coverage. Eligible individuals remain enrolled in their existing coverage group.

A LaCHIP or BCC applicant/beneficiary may have insurance coverage if purchased through the LaHIPP program. If Medicaid is reimbursing the premium through LaHIPP, this coverage is not considered creditable health insurance and does not impact LaCHIP or BCC eligibility.

LaHIPP reimburses the cost of employer-sponsored or individual health insurance premiums for the policyholder and Medicaid-eligible dependents when coverage is determined to be cost-effective.

Medicaid covers insurance co-payments and deductible if the beneficiary’s provider is in the health insurance plan's network and accepts Medicaid as a secondary payer, and the beneficiary follows all plan guidelines. If an individual covered on the health insurance policy is not a Medicaid beneficiary, they are responsible for their own copays, coinsurance and deductibles.

H-3903 Eligibility Determination Process

LaHIPP Eligibility Advisors are responsible for making the eligibility determination.

H-3904 Cost-Effectiveness

Cost-effectiveness means the total amount the state pays for premiums and required cost-sharing is less than what it would cost Medicaid to provide the same services directly. The Louisiana Department of Health (LDH) determines cost-effectiveness using established methodology and projected Medicaid expenditures.

Cost-Effective Methodology

1. To determine the total cost of ESI/IHI participation, add the following:

• Annual Premium Cost • Deductible o If enrolled 12 months or more, use actual deduction o If enrolled less than 12 months, calculate 60%