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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued January 6, 2026 Page 2 of H-800 Replacing August 11, 2025 Revised/added text indicated by underscore Deleted text indicated by “**” ● A Medicare certified skilled nursing facility (SNF); or

● A Medicaid certified ICF/IID facility. H-810.1 Coverage Medicaid will pay all or part of the facility fee, in addition to a full range of Medicaid services, for eligible applicants/beneficiaries. The Medicaid facility fee payment is referred to as the vendor payment.

Medicare Part A

Medicare Part A covers Medicare skilled nursing care facility (SNF) services. Refer to H-840. H-810.2 Medical Certification The medical certification determination is not a disability determination. Refer to I-1000 Medical Certification.

Care is given and vendor payment is made to the nursing or ICF/IID facility according to the medical needs of the resident. ICF/IID facilities are certified to provide ICF/IID services only.

Before LTC vendor payment can be authorized for any applicant/beneficiary an evaluation of the individual's medical needs is completed by the facility and the applicant’s/beneficiary’s physician in order to recommend a level of care (LOC).

An evaluation of the recommended level is made by Office of Aging and Adult Services (OAAS), Office for Citizens with Developmental Disabilities (OCDD) or its designee to determine the need for facility care and the level of care required. The decision may be for a different LOC than the recommended level or that nursing care is not the appropriate placement for the applicant/beneficiary.

All individuals seeking admission to a nursing facility require a medical certification from the OAAS and/or the appropriate Level II authority prior to admission. If the individual meets nursing facility LOC, OAAS issues the Form 142 Notice of Medical Certification. Once the approved Form 142 has been obtained, the individual must be admitted to the facility within 30 calendar days of the date of the approval.