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Louisiana Medicaid Eligibility Manual Eligibility Factors

Reissued August 29, 2022

Page 1 of I-1000 Replacing January 21, 2022

Deleted text indicated by “” Revised/added text indicated by underscore

I-1000 MEDICAL CERTIFICATION

I-1010 REQUIREMENT

I-1010.1 Long-term Care and Home and Community Based Services Only

An individual must meet Long-term Care (LTC) medical certification criteria to be eligible for nursing facility (NF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) vendor payment or Home and Community Based Services (HCBS). To meet this criteria the individual must meet the level of care for institutionalization in a nursing facility or ICF/IID.

The level of care determination is made by the Office of Aging and Adult Services (OAAS), the Office for Citizens with Developmental Disabilities (OCDD) or the designees of each agency for the respective programs.

OAAS

• Nursing Facility Admission • Home and Community Based Waivers – Community Choices Waiver (CCW) – Adult Day Health Care (ADHC)

OCDD

• ICF/IID Admission • Home and Community Based Services – New Opportunities Waiver (NOW) – Children’s Choice Waiver (CC) – Supports Waiver (SW) – Residential Options Waiver (ROW)

The medical certification is separate from and unrelated to any determination of disability made by MEDT or SSA/SSI.

Nursing Facility Admission

Eligibility will be the later of the medical certification approval date, the date of admission, or the date that financial eligibility is established.