Page 2
Louisiana Medicaid Eligibility Manual Eligibility Factors
Reissued August 29, 2022
Page 2 of I-1000 Replacing January 21, 2022
Deleted text indicated by “” Revised/added text indicated by underscore
For individuals seeking admission to a Medicaid-certified nursing facility, regardless of the source of payment for the nursing facility services, the medical certification shall be obtained from the Office of Aging and Adult Services (OAAS) and/or the appropriate Level II authority prior to admission.
The individual must be admitted to the facility within 30 days of the date of the medical certification. If the individual is not admitted within 30 days of the certification approval date, a new medical decision is needed. If a time limited (temporary) medical certification is issued, it is the responsibility of the nursing facility to submit a continued stay request to OAAS timely to avoid a lapse in Medicaid vendor payment.
The pre-admission process is applicable for nursing facility admission and is not applicable to ICF/IID and HCBS Waivers.
ICF/IID Admissions
Eligibility will be the later of the medical certification approval date, the date of admission, or the date that financial eligibility is established.
Home and Community Based Services
Eligibility will be the later of the medical certification approval date, or the date that financial eligibility is established.
I-1010.2 Louisiana Coordinated System of Care only
The Coordinated System of Care (CSoC) was developed for Louisiana’s children and youth with significant behavioral health challenges that are in or at risk of out of home placement. To receive services through the Louisiana Behavioral Health Partnership (LBHP) or Coordinated System of Care (CSoC), individuals must meet a level of need and in some instances a level of care for nursing facility or hospital placement.
Individual assessments are made by the CSoC Contractor’s Care Manager and submitted to the CSoC Contractor. The CSoC Contractor submits approvals for eligible individuals.
A new determination will be made every 6 months for CSoC children.