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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Reissued January 6, 2026 Page 8 of H-800 Replacing August 11, 2025 Revised/added text indicated by underscore Deleted text indicated by “**” below the SIL. H-830.2 Special Income Level Income eligibility is based on the applicant/beneficiary's gross income, excluding Veterans Administration (VA) aid and attendance.

The applicant/beneficiary’s gross earned and unearned income is compared to the SIL rate. The SIL is three (3) times the monthly SSI Federal Benefit Rate (FBR) for an individual. The couple SIL is double the individual SIL. Refer to Z-700 LTC/HCBS SIL Rate, Resource Limits and Personal Care Needs Allowance.

For applicants/beneficiaries whose income exceeds the SIL, continue reviewing eligibility under the 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.

Exception:

There is no eligibility for LTC Spend-Down MNP in ACH.

H-830.3 Personal Care Needs Applicants/beneficiaries are allowed to keep a protected amount of money from their monthly income to spend on personal care needs items not covered by the facility fee. Refer to Z-700 LTC/HCBS SIL Rate, Resource Limits and Personal Care Needs Allowance.

H-830.4 SSI Recipients SSI recipients who enter a LTC facility remain eligible for Medicaid if they continue to receive an SSI payment while in the facility and may be eligible for nursing facility vendor payment.

There are three (3) circumstances under which vendor payment to an LTC facility may be denied for an individual who receives SSI and has been medically certified to receive nursing facility services. They are:  A Medicaid Qualifying Trust (MQT) exists;  An OBRA ’93 trust exists; or  There has been a transfer of resources for less than fair market value (FMV). Note: Refer to I-1700 Trust to determine if the Trust is a