Page 2

Louisiana Medicaid Eligibility Manual Eligibility Factors

Issued April 18, 2022

Page 2 of H-700 Replacing November 1, 2000

Deleted text indicated by “**” Revised/added text indicated by underscore Verify any questionable information that affects eligibility. Document in the case record how any questionable information was verified.

H-713 RETROACTIVE CERTIFICATION

** Individual(s) requesting retroactive medical benefits shall have had a medical service during at least one of the months for which RME is considered. (It is permissible to accept the applicant's verbal statement.)

The retroactive period may consist of any or all of the three months immediately prior to the month of SSI application. The months of retroactive eligibility do not have to be consecutive.

Example: The beneficiary applied for SSI in June and is certified for SSI and Medicaid effective that month. The worker learns that the beneficiary had unpaid medical bills incurred in April. The beneficiary met all eligibility requirements for March and April, but ** was not income eligible for May. Certify the beneficiary for RME for March and April. Consider eligibility in Medically Needy Program (MNP) for May.

Note: Continuous eligibility begins in the month of application rather than the first month of eligibility. See H-1900 Twelve Months Continuous Eligibility for more information.

H-714 DENIAL FOR SSI BECAUSE OF DISABILITY

If SSA denied an application because SSI disability was not met, explore the possibility that disability existed for the year immediately preceding the SSI application date.

If the applicant states that disability was continuous throughout the 12 months prior to SSI application, submit ** an MEDT package for a disability decision for the three month period of potential retroactive eligibility.

If the applicant states there was no disability during this one-year period, explore Magi-Related programs. If not eligible for any Medicaid program, deny the application for retroactive coverage.