Page 26

Louisiana Medicaid Eligibility Manual Eligibility Factors

Issued January 7, 2026 Page 26 of I-1550 Replacing November 13, 2025

Revised/added text indicated by underscore Deleted text indicated by “**” when less than the tax filing threshold. 3. Allow the five (5) percent disregard on MAGI budgets. 4. Compare the combined net countable income for the individual’s household to the applicable income standard for the household size. Refer to Z-200 Federal Poverty Income Guidelines. o If the countable income is at or below the income standard for the applicable MAGI group, the individual is income eligible. o If the countable income is above the income standard for the applicable MAGI group, the individual is income ineligible.

I-1556 GAP-FILLING RULE - FINANCIAL ELIGIBILITY

Gap filling is a component of the MAGI-based financial methodology for Medicaid/CHIP. The gap filling rule only applies to the individual’s finaincial eligibility determination. The individual must meet all other eligibility factors, including the requirements for an eligibility group.

Due to differences in eligibility rules, an individual may be financially ineligible for both Medicaid under the MAGI (Modified Adjusted Gross Income) rules used for Medicaid/CHIP and for the Advance Premium Tax Credit (APTC) under the MAGI rules used by the Marketplace for determining APTC. This results in a coverage gap where the individual may be determined to have monthly household income too high for Medicaid/CHIP and have annual household income too low for APTC.

Under the gap filling rule, financial eligibility for Medicaid/CHIP is determined using the household income as calculated for APTC purposes. Medicaid/CHIP-specific rules shall not be applied for the purposes of gap filling. This includes tax dependent exceptions, treatment of lump sum payments, and budgeting of current monthly income.

The Federally Facilitated Marketplace (FFM) bases APTC eligibility on annualized income. The household income used for APTC eligibility includes projected annual income for the entire calendar year. The household’s projected annual income must be at least 100% FPL but not exceed 400% FPL to qualify for APTC.