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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued January 6, 2026 Page 5 of H-800 Replacing August 11, 2025 Revised/added text indicated by underscore Deleted text indicated by “**” Income eligibility is based on the MAGI income and household composition prior to admission to the facility. The countable income is compared to the applicable MAGI-based program. Refer to Z-200 Federal Poverty Income Guidelines. If eligible, the individual may remain in the MAGI-based eligibility determination for the month of admission and three additional months before determining eligibility for MAGI-based LTC or Non-MAGI LTC.

Individuals who are not eligible for MAGI-based LTC must be evaluated for Non-MAGI LTC (e.g. adult group, aged, blind or disabled). Refer to H-830 Non-MAGI Long Term Care.

H-821 ELIGIBILITY DETERMINATION PROCESS Determine eligibility by applying the following criteria. The elements have been listed in the most logical order, but work on all steps simultaneously.

Cases in categories F, V, O, I are the responsibility of DCFS. Refer a case certified in one of these categories to DCFS for the LTC determination of eligibility. H-821.1 Determine Assistance/Benefit Unit Refer to the MAGI-based assistance/benefit unit that the institutionalized applicant/beneficiary was or could be included in.

Note: Individuals whose eligibility has or has not been established in the Adult Group cannot be considered for MAGI-based LTC. Eligibility must be considered for Non-MAGI LTC.

H-821.2 Establish Categorical Requirements

Verify the institutionalized applicant is certified for a MAGI-based program or Regular MNP.

If the institutionalized applicant is not included in an active certification, verify the individual meets all the eligibility criteria for a MAGI-based program or Regular MNP if he/she had applied.

H-821.3 Establish NonFinancial- Eligibility Verify eligibility for the applicant/beneficiary with regard to the following factors:

 Age – MAGI-based I-100