Page 26

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued January 6, 2026 Page 26 of H-800 Replacing August 11, 2025 Revised/added text indicated by underscore Deleted text indicated by “**” determines that extenuating circumstances require additional time.

The request for the exception may be made by the applicant/beneficiary, his representative, or the facility in which he resides.

The individual must provide to the department sufficient documentation to support, by a preponderance of the evidence, the claim that application of the penalty will result in an undue hardship to the applicant/beneficiary; not to the community spouse.

Note: The community spouse is not protected by the hardship exception. The exception is for the applicant/beneficiary not to be deprived.

An undue hardship exception may be requested at any time during the penalty period if new circumstances leading to undue hardship arise during the duration of the penalty period. If granted, the undue hardship request shall be prospective from the date of the request. All requests for exceptions shall be referred to the Eligibility Policy Section with detailed documentation. If additional information is needed to make the exception determination, a notice shall be sent to the person making the request specifying the type of additional information needed and the time within which to provide the additional information.

Once LDH determines that it has received complete documentation, it shall inform the individual within ten (10) business days of the undue hardship decision.

If a request for undue hardship is not received within seven (7) days after notification of transfer penalty, or if the request is denied, LDH shall issue an eligibility determination specifying the applicable penalty period. If the individual is a beneficiary, the notice shall include the date of the Medicaid LTC termination. The notice shall include the right to request a fair hearing and continuing benefits while their appeal is pending.

LDH shall have no obligation to pay for long-term care services during the penalty period unless it grants an undue hardship exception or the applicant/beneficiary prevails in a fair hearing.