Page 10

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 1, 2026

Page 10 of H-900 Replacing June 08, 2021 Revised/added text indicated by underscore

Deleted text indicated by “”

H-910.3 Special Income Level (SIL)

Income eligibility is based on the applicant/beneficiary gross income (excluding VA Aid and Attendance).

Gross income is compared to the SIL rate. The SIL rate for HCBS is three times the Supplemental Security Income (SSI) Federal Benefit Rate (FBR) for an individual. Refer to Z-700 LTC/HCBS SIL Rate, Resource Limits and Personal Care Needs Allowance.

Review eligibility under the HCBS Spend-Down Medically Needy program for an applicant/beneficiary eligible to participate in the Community Choices, ADHC, Supports, NOW, or ROW waivers, but who has countable gross monthly income over the SIL. Refer to H- 1050 Spend-Down Medically Needy - Home and Community Based Services – SSI-Related. Review eligible under the Regular and Spend-down Medically Needy program for an applicant/beneficiary eligible to participate in CSOC- SED (only), but who has income over the SIL. Refer to H-1020 Regular and Spend-Down Medically Needy - MAGI-Related. Refer to H-1030 Spend-Down Medically Needy - SSI related.

H-910.4 SSI Recipients

SSI recipients who admit to an HCBS waiver remain eligible for Medicaid and may be eligible for HCBS vendor payment.

There are three (3) circumstances under which vendor payment to an HBCS provider may be denied for an individual who receives SSI and has been medically certified to receive Home and Community Based 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 Trusts to determine if the Trust is a countable resource to the SSI recipient or if it will be treated as a transfer of resources.