Page 20

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued January 6, 2026 Page 20 of H-800 Replacing August 11, 2025 Revised/added text indicated by underscore Deleted text indicated by “**” Qualified Medicare Beneficiary (QMB) or H-1300 Specified Low- income Medicare Beneficiary (SLMB).

H-841.6 Certification Period The certification period cannot exceed three (3) months beginning with the first month of eligibility for Medicaid coinsurance because coinsurance is limited to up to 80 days.

The facility is responsible for notifying Medicaid of the first day of the coinsurance.

Eligibility for coinsurance cannot extend beyond the month in which the Medicare payment ends. The facility is responsible for notifying Medicaid of the last day of Medicare payment.

Note: Because the beneficiary has no PLI while on Medicare/Medicaid coinsurance, he may retain all or most of his income, which may cause an increase in resources. At certification, notify the applicant/responsible person that:

● Resource eligibility is a factor for continued eligibility in coinsurance, and for LTC vendor payment after the coinsurance period ends; and

● It is their responsibility to report if resources exceed the resource limit as of the 1st moment of the month.

 It is the responsibility of the analyst to verify resources prior to the start of vendor payment.

H-841.7 Notice of Decision

Send the notice of decision to the applicant/beneficiary.

Send a copy to the facility.

Note: If the Medicare skilled determination originally made by the Facility Utilization Committee is later denied by Medicare, change the type case on MEDS and issue notification of Medicaid eligibility.