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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued January 6, 2026 Page 1 of H-800 Replacing August 11, 2025 Revised/added text indicated by underscore Deleted text indicated by “**” H-800 INDIVIDUALS IN INSTITUTIONS - SPECIAL INCOME LEVEL

H-800.1 General Information

Medicaid coverage is available to individuals in institutions whose income is less than or equal to the special income level (SIL). This includes individuals in a:  Nursing facility; or  Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). The special income level is also used to determine income eligibility for:  Home and community-based services (HCBS) waiver; or  Program of All-Inclusive Care for the Elderly (PACE).

Determine income eligibility by comparing the individual’s gross earned and unearned income, before deductions, to the SIL standard. The SIL standard is equal to three times the SSI Federal Benefit Rate (FBR) for an individual.

Note: For individuals applying for nursing facility care or HCBS waiver (Adult Day Health Care (ADHC), Community Choice Waiver (CCW), New Opportunities Waiver (NOW), Supports Waiver (SW) and Residential Options Waiver (ROW)) whose income exceeds the SIL, continue reviewing eligibility under the Spend-Down Medically Needy program.

Eligibility under the SIL is applicable to a period of institutionalization likely to be at least 30 consecutive days. Refer to I-400 Continuity of Stay.

H-810 LONG TERM CARE (LTC) PROGRAM

An applicant/beneficiary may be eligible for Medicaid services in the LTC program if he/she is a resident of:

● A Medicaid certified nursing facility (NF);