Medicaid Eligibility Update

Why is the State notifying people they may lose Medicaid eligibility?

The budget does not have enough funding for the critical needs of the state. In order to wind down programs that may be eliminated, a lengthy regulatory process must take place. As this process is underway, it is important to keep people as informed as possible. As of today, people will continue to receive their benefits.

How many people are currently enrolled in Medicaid under these eligibility categories?

An estimated 37,000 people and their families and those who provide services. This includes people in nursing homes, community homes or other facilities for people with disabilities and some people who receive community-based waivers.

Who would be impacted by the loss of these eligibility categories?

People who are impacted get their Medicaid from four eligibility categories:

  • Provisional Medicaid covers individuals who are either age 65 and older or disabled with monthly income less than $750.
  • The Medically Needy and Medically Needy Spend Down Programs cover some individuals whose medical expenses exceed their income.

The Long Term Care Special Income Level program covers individuals who are aged, blind or disabled who qualify for institutional level of care because of their medical needs and who have monthly income between $750 and $2,250.

How are these categories different from normal Medicaid eligibility?

Each of these eligibility programs are designed to meet the unique needs of people who are aging, disabled or have excessive medical bills. In almost all cases, they do not otherwise qualify for Medicaid. However, once enrolled, all of these recipients get the same full benefit Medicaid coverage as everyone else.

Since we are talking about mostly adults, can’t they qualify under Medicaid expansion?

People who are older than age 65 or have Medicare are not eligible for coverage under expansion. There is a possibility that some younger people may qualify under a different eligibility program. Also, income is a factor. We will look at every individual and his or her situation to make sure we help them explore all of their options.

In addition to eligibility, aren’t there going to be program cuts or eliminations?

Yes. Several Medicaid services also may end. These include:

  • Pediatric Day Health Care program that serves medically fragile children from birth up to age 21 may be eliminated.
  • Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) may be eliminated for people age 21 and older with serious mental illness.
  • Outpatient drug and alcohol treatment services may be reduced for people with a Substance Use Disorder.
  • Ambulatory, or same day surgery services may be eliminated.

What will happen to health care providers if a majority of their patients/residents no longer have a payer source?

We expect this will have an impact on any provider who serves Medicaid patients. This is a major concern for the Department not only for now but for the future, as there is a possibility that some providers may go out of business and not be able to reopen if they lose Medicaid patients for as little as a month.

Are there other options for people who will lose their eligibility?

We are reviewing all cases on an individual basis to see if there are other eligibility categories that they might qualify for. This is a federal requirement before any eligibility termination can occur.

Why are letters going out now?

Two reasons. First, we want to give everyone impacted by this cut as much notice as possible in order to make plans for such a change and begin the process of seeing if individuals may be eligible for other services. We know from speaking with some individuals and their families already that explaining these complex reductions can take time.

Second, because of federally required timelines and approval processes, we must start the public notice step of rulemaking, CMS notification and their approval process. This could be lengthy. We believe it to be responsible to explain to enrollees what that public notice means, provide advice on applying for other available programs, and how to contact us if they have questions.

Does the State have the final authority to make this change in eligibility?

No, we still need approval from the federal Centers for Medicare and Medicaid Services, CMS.

Are there any resources to help or assist those who are losing eligibility?

To the best of our ability, we will do everything possible to help people understand their options and to connect them to local services.

Do people who qualify for Supplemental Security Income automatically qualify for Medicaid?

Yes, it is a group mandated by federal CMS regulations.

Why should I apply for Supplemental Security Income (SSI) now?

If you qualify for SSI, you automatically qualify for Medicaid.  Regardless of what happens with the state budget, SSI ensures continued Medicaid eligibility.

How do I apply for SSI?

SSI is not a state program.  There are three ways you can apply for SSI through the Social Security Administration with the federal government:

The easiest way to get direct information on applying for SSI is to go in person to an SSA office.  Sometimes call wait times can be long and we recommend you go in person if possible.

What is the Long Term Care Special Income Level program?

The Long Term Care Special Income Level program covers individuals who are aged, blind or disabled and who qualify for institutional level of care because of their medical needs with monthly income over $750.  These members are either in facilities such as nursing facilities or group homes or may be receiving home and community-based waiver services (HCBS).

Who will Supplemental Security Income help?

Currently, the only recipients in the Special Income Level group whose eligibility is not impacted are those receiving Supplemental Security Income (SSI). Non-SSI recipients would fall into the Special Income Level group even if the income is less than $750 and could be impacted by the budget cuts.  Waiver recipients will lose waiver benefits unless they are eligible and receive SSI.

We recommend you apply for SSI if you have not already done so in order to protect your current Medicaid eligibility.  It can sometimes take around six months for an SSI eligibility determination to be made by the federal government.

I have SSDI; does that qualify me? What is the difference between SSI and SSDI?

Social Security Disability Income (SSDI) is not the same as Supplemental Security Income (SSI).  SSDI is based on an individuals’ earnings record.  Whereas, Supplemental Security Income (SSI) serves the needy and eligibility is based on having limited income and resources.  It is possible for an individual to qualify for both SSDI and SSI benefits but you must apply for SSI with the Social Security Administration to retain Medicaid eligibility if there are budget cuts to these programs.  Having SSDI will not maintain your eligibility.

Who among the four eligibility groups would benefit from our instruction to apply for SSI?

Anyone who is 65 or older or have a disability with income below $750. There could even be some in the special long-term care income limit program who have income less than $750 and never applied for SSI, or have resources over the SSI limit. Medicaid also has provisions for spousal impoverishment considerations.

What should I do now?

As of today, there are no changes to your benefits.

Should I reapply for Medicaid?

No. We want to keep you in your current eligibility group as long as possible and you should continue to access your benefits.  However, it is important that you make sure all your information with us is up to date. This includes your contact information and income information, so that we can be in the best prepared position for when the legislature decides on a state budget. Our call center can help you with that.

Should I keep going to the doctor?

Yes. You should continue to go to the doctor and use your benefits until you hear otherwise from Louisiana Medicaid. This notice will come in a mailed letter. 

Is it OK to schedule an appointment with the doctor?

If you are overdue for medical care, make an appointment with your provider as soon as possible.

Be sure to keep your contact information up-to-date at We will be communicating with you through the mail, so this is important to make sure you have the latest information.

Are the waivers going away?

No.  However, waiver recipients who qualify for Medicaid because they are in the long-term care special income level program will be impacted.  The only waiver recipients in the long-term care special income level program whose eligibility is not impacted are those receiving Supplemental Security Income (SSI). 

How will you let me know when my coverage ends or changes?

Before these programs end, you will receive a letter from Louisiana Medicaid letting you know whether there is any change to your Medicaid coverage.

Where can I find more information?

We understand that you may have questions and concerns. We will do our best to keep you informed through our web site Our call center is also available from 7 a.m. to 6 p.m., Monday through Friday, by phone toll-free at 1-888-342-6207, or e-mail at

How can I keep in touch to make sure I know of any changes?

Be sure to keep your contact information up-to-date at or by calling our call center to speak to a representative to update your information. We will be communicating with you through mail, so this is important to make sure you have the latest information

Is it true that a budget has been passed and many disabled people will be able to keep their benefits?

As the legislature enters a special session starting May 22, 2018, the budget is still not final and the Department still does not know what we will be able to fund come July 1, 2018.