Page 8

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 1, 2026

Page 8 of H-900 Replacing June 08, 2021 Revised/added text indicated by underscore

Deleted text indicated by “”

Waiver services are covered in addition to regular non-institutional Medicaid services.

H-910.2 Medical Certification

Medical certification requires that the applicant meet the level of care requirements for the waiver program for which he/she is applying.

Therefore, before HCBS vendor payments can be authorized for any applicant, a comprehensive report and evaluation of the individual's medical needs must be completed.

For all waivers, except CSoC-SED

The waiver applicant's physician completes a report and evaluation and recommends a specific classification of care. The report and recommendation are submitted with the plan of care to the Office of Aging and Adult Services (OAAS) or its designee for ADHC and Community Choices, and to the Office for Citizens with Developmental Disabilities (OCDD) for NOW, Children’s Choice, Supports and ROW regional office staff for approval.

The plan of care is prepared by the following entities for each respective waiver:

ADHC – the potential ADHC provider; Community Choices – the support coordinator; Children’s Choice – the support coordinator; NOW – the support coordinator or OCDD if applicant is not already Medicaid eligible; ROW – the support coordinator; and Supports Waiver – the support coordinator.

For cases with a Level II assessment, the first day of eligibility for HCBS is no earlier than the effective date indicated by the Office of Behavioral Health (OBH) or OCDD regional office on BHSF Form 142, or the date financially eligibility is established, whichever is later.

Medical certification must be obtained any time the beneficiary's medical needs indicate a change in level of care or the beneficiary