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Louisiana Medicaid Eligibility Manual Eligibility Factors

Issued May 16, 2022

Page 3 of H-1620 Revised/added text indicated by underscore

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I-1625 VERIFICATION OF PAID INSURANCE BENEFITS

Written verification from the insurance carrier of benefits is required.

The insurance carrier must verify the following policy information before the resource disregard can be applied for Medicaid eligibility or estate recovery purposes: • LTCP policy status, • Amount of insurance benefit payments made by the policy prior to application or renewal, and • The amount of benefits remaining. The Explanation of Benefits (EOB) statement is an acceptable form of paid benefits verification. Note: Insurance benefit payments, for purposes of resource disregarded when applying for Medicaid, are payments made for LTC benefits and services and do not include benefits such as cash surrender values, return of premiums, premium waiver, or death benefits.

I-1626 RESOURCES IN THE ELIGIBILITY PROCESS

The disregarded resource is determined on a 1:1 ratio. The amount of the disregard is equal to the amount of the insurance benefit payments made to or on behalf of the individual.

The resource rules used to determine eligibility for the LTC programs apply to this program with the exception of the resource disregarded.

The resource disregard can only apply to the resources owned by the policyholder/beneficiary. Once it is determined the policyholder is entitled to a resource disregard, the verified amount of benefits paid will be applied in the form of a deduction and will reduce the value of policyholder’s countable resources. These disregarded resources are protected from estate recovery.