Page 11

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 1, 2026

Page 11 of H-900 Replacing June 08, 2021 Revised/added text indicated by underscore

Deleted text indicated by “” Transfer of resources for less than FMV made by the SSI recipient must be explored before determining eligibility for vendor payment. Refer to I-1670 Transfer of Assets For Less Than Fair Market Value.

H-910.5 Patient Liability

There is no patient liability for an HCBS applicant/beneficiary who has countable gross income below the SIL. Refer to H-910.5, Maintenance Needs Allowance and Z-700 LTC/HCBS SIL Rate, Resource Limits and Personal Care Needs Allowance .

An applicant/beneficiary eligible to participate in the Community Choices, ADHC, Supports, ROW, or NOW under the HCBS Spend- Down Medically Needy program may have a patient liability. The patient liability is based on the amount of income remaining after the allowable deductions. Refer to H-1050 Spend-Down Medically Needy - Home and Community Based Services - SSI Related.

H-910.6 Maintenance Needs Allowance

HCBS beneficiaries are allowed maintenance needs allowance up to three (3) times the FBR.

H-910.7 Categories F, V, I, and O

The Louisiana Department of Children and Family Services (DCFS) Child Welfare office is responsible for determining HCBS eligibility and patient liability for children in state custody who are certified in categories F, V, I, and O.

H-920 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.

H-921.1 Determine Assistance Unit

The assistance unit consists of the applicant/beneficiary.