Page 10

Louisiana Medicaid Eligibility Manual Eligibility Factors

Reissued October 21, 2025 Page 10 of I-1670 Replacing January 27, 2025 Revised/added text indicated by underscore Deleted text indicated by “**” bathing, dressing, grooming, transferring, toileting, and eating. The PCA shall be considered a transfer for less than FMV unless all of the following mandatory provisions are met:

• The agreement provides for the provision of reasonable and necessary medical care or assistance, which is not otherwise covered by Medicare, Medicaid, or private insurance.

• The agreement must be in writing and properly executed prior to the service or assistance being provided. The agreement cannot be applied retroactively to pay for services or assistance that was provided prior to the agreement.

• The agreement must specify the type of service to be provided, the frequency for providing the service, the time to be spent providing the service or assistance, and the amount of compensation to be paid for the service.

• The agreement must provide for payment upon rendering of the services or assistance, or within 30 days thereafter.

• The agreement must be supported by evidence that services and payments were made in accordance with the agreement.

• The caregiver cannot be the spouse or parent of the applicant/beneficiary.

• The applicant/beneficiary or his/her legally authorized representative has the power to modify, revoke, or terminate

the agreement.

A PCA that fails to contain all of the mandatory provisions is considered a transfer for less than FMV. Payments made under the written agreement that do not have the mandatory provisions will be considered as the amount transferred.

If a written agreement meets the mandatory requirements, it must be determined whether adequate compensation in the form of services or assistance was provided.

Adequate compensation shall be measured against the usual and customary charges for these services in the local area. If services or assistance require extraordinary skill, the provider or caregiver must possess the required skill, experience, or expertise. These services or assistance may be valued in accordance with similar services in the