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Louisiana Medicaid Eligibility Manual Eligibility Factors

Issued January 7, 2026 Page 28 of I-1550 Replacing November 13, 2025

Revised/added text indicated by underscore Deleted text indicated by “**” • The monthly income exceeds the Adult Group (AG) income limit of $2,433 (138% FPL). Annualized income test (January -December): • $1500 x 5 months = $7,500 (Susan) + $1083 x 12 months = $12,996 (Jon) = $20,496 total annual household income. Susan and John are over the income limit when evaluated on a monthly basis but their annualized income of $20,496 falls below 100% FPL annual income limit of for a household size of two ($21,150). Applying the gap-filling rule shows they remain eligible for Adult Group (138% FPL). Note: If an individual is ineligible due to income, evaluate for Spend- Down Medically Needy – MAGI-Based. See H-1020 Regular and Spend Down Medically Needy – MAGI-Based. Gap-filling methodology may also be used to determine retroactive eligibility, provided the individual's projected annual income is below 100% FPL and all other requirements are met. Retroactive coverage is limited to the standard three-month period prior to the application month, unless otherwise specified by policy. See H-1800 Retroactive Medical Eligibility (RME). I-1556.2 GAP-FILLING RENEWALS

A redetermination of financial eligibility of each individual determined eligible using gap-filling rule must be completed by January of the following calendar year.

Note: Redetermine eligibility for children under age 19 with 12 months continuous eligibility and indiviudals eligible for 12 months postpartum eligible when the continuous eligibility period ends.