Page 3
Louisiana Medicaid Eligibility Manual Eligibility Factors
Reissued August 29, 2022
Page 3 of I-1000 Replacing January 21, 2022
Deleted text indicated by “” Revised/added text indicated by underscore
I-1010.3 Program for All-Inclusive Care for the Elderly (PACE) only
The PACE organization provides services to frail elderly qualifying individuals who require the level of care provided in a nursing facility. PACE programs provide services primarily in an adult day health center and are supplemented by in-home and referral services in accordance with the enrollee’s needs.
The PACE provider completes an individual assessment of the enrollee for OAAS to review. OAAS determines whether the enrollee meets the level of care required to receive services through the PACE program.
Eligibility will be the first day of the calendar month following the date the signed enrollment agreement is received by the PACE organization if the individual meets Medicaid financial eligibility and medical certification approval.
I-1010.4 ACT 421 Children’s Medicaid Option (TEFRA)
The Act 421-CMO program provides healthcare services to children with complex medical needs living at home that are under the age of 19, regardless of parental income and resources.
The Office for Citizens with Developmental Disabilities (OCDD) Local Governing Entity (LGE) completes the assessment for children needing services and determines if the level of care requirement is met.
Eligibility will be the later of the medical certification approval date, or the date that financial eligibility is established.
I-1011 LEVEL TWO SCREENING FOR ADMISSION TO LTC INSTITUTIONS/FACILITIES
Level Two Screening is an additional assessment of the appropriate placement for all new admissions with a diagnosis of mental illness (MI) or intellectual disability (ID). The medical certification may be delayed pending completion of the Level Two Screening.
A Medicaid-certified nursing facility shall not admit an individual with a diagnosis of a serious MI or ID without a preadmission screening and a decision from the Level II authority.