Page 14

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 1, 2026

Page 14 of H-900 Replacing June 08, 2021 Revised/added text indicated by underscore

Deleted text indicated by “” Regular and Spend-Down Medically Needy - MAGI-Based. Refer to H-1030 Spend-Down Medically Needy - SSI Related. If the total gross income is equal to or less than the SIL, the applicant/beneficiary is income eligible. Continue the determination of need.

Note: Consider QMB or SLMB eligibility for all HCBS applicants. Refer to H-1100 Qualified Medicare Beneficiary (QMB) or H-1300 Specified Low-income Medicare Beneficiary (SLMB).

Couples Receiving HCBS

Beginning with the month each member of a married couple is offered a waiver opportunity, determine whether it is to the couple’s advantage to have eligibility reviewed: • As a couple; or • As individuals.

First, consider eligibility for each applicant as an individual using the individual SIL.

If one member of the couple has gross income which is greater than the individual SIL, consider eligibility as a couple using the couple SIL.

If the total combined gross income of the couple is equal to or less than the couple SIL, the couple is income eligible. Continue the determination of need.

If eligibility for HCBS is established using the couple SIL, consider eligibility for QMB or SLMB using the couple QMB or SLMB standard.

If the total combined gross income of the couple is greater than the couple SIL rate, the couple is income ineligible. Eligibility for each applicant must be reviewed using the individual SIL.

If the total gross income of the individual is over the SIL, the applicant is income ineligible. Applicants/beneficiaries eligible to participate in the Community Choices, ADHC, Supports, NOW, or ROW waivers, should be considered for eligibility under the HCBS Spend-Down Medically Needy Program. Refer to H-1050 Spend-