Page 51

Louisiana Medicaid Eligibility Manual Eligibility Factors

Reissued August 11, 2025

Page 51 of I-1530 Replacing February 17, 2025

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

Step 5. Subtract all allowable medical insurance premiums and other allowable medical bills. Refer to I-1536 Deductions.

Step 6. The remainder is the patient liability owed by the applicant/beneficiary for their cost of care. This is the projected PLI.

Reconciliation

PLI is reconciled at the end of the projection period or when a change in income or deductions occurs. • Limit changes in income to the three months prior to the reported on date. • Deductions are required to be reported within 3 months of the date of service. The projected PLI will be reconciled against the actual PLI for the three months prior to the date the change was reported. Any differences will be carried forward to the first month in which PLI is allowed to be adjusted per Advance Notice rules. Refer to MEM L-700 Advance Notice.

During reconciliation verify the actual income and deductions for each of the prior three months and determine the actual PLI for each month. Any difference between the projected PLI and the actual PLI will be reflected as a cumulative positive or negative amount called a carryforward for each month. • Any carryforward remaining after the first adjustable month is combined with the projected PLI for subsequent months until completely absorbed. • One-time, non-recurring deductions should also be combined with the new projected PLI in addition to the carryforward if there is one.

I-1538.1 Patient Liability Notice

Send the Quarterly Patient Liability Summary Notice to the applicant/beneficiary/authorized representative and the provider every three months from the certification/renewal month with the next