Page 14

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued January 6, 2026 Page 14 of H-800 Replacing August 11, 2025 Revised/added text indicated by underscore Deleted text indicated by “**”

If ineligible based on income, consider for Spend-down MNP. Refer to H-1030 Spend-Down Medically Needy - SSI-Related or H-1040 Spend- Down Medically Needy - Long Term Care - SSI Related.

If the applicant/beneficiary is LTC eligible, determine the OSS payment and patient liability.

If the applicant/beneficiary is not eligible for vendor payment because of transfer of resources or equity interest in the home exceeds the established limit, the applicant/beneficiary is responsible for the entire LTC payment and he is not eligible to receive an OSS payment. H-831.6 Post Eligibility Determination

Determine OSS Payment

The OSS payment is for an applicant/beneficiary residing in a nursing or ICF/IID facility who has gross income of less than $38.00.

Refer to J-300, Optional State Supplement (OSS) Payments.

Determine Patient Liability

Post-eligibility treatment of income (PETI) rules are used to calculate an applicant/beneficiary’s contribution to their cost of care for nursing home, Home and Community Based Waiver or ICF/IID services. Also called patient liability (PLI). PLI is the amount the applicant/beneficiary must pay towards their monthly cost of care. It is based on the amount of monthly income remaining after allowable deductions.

Refer to I-1538 Patient Liability-Post Eligibility Treatment of Income (PETI) for the Patient Liability Calculation Process.

If the applicant/beneficiary has a community spouse, refer to I-1537 Spousal Impoverishment Income Provisions.

Note: After eligibility for a couple has been established using the couple SIL, income may be divided to the advantage of the couple but not to the disadvantage of the agency in determining the PLI for each applicant/beneficiary.