Medicaid Eligibility Manual

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This Policy is used to determine eligibility for coverage in Louisiana Medicaid Programs. It is applied to determine eligibility for new applications and for on-going coverage.

Preface / Explanatory Notes

A - 0000 Abbreviations / Acronyms / Definitions

• A - 100 Abbreviations and Acronyms
• A - 200 Definitions

B - 0000 Introduction

C - 0000 Medical Services

D - 0000 Reserved

E - 0000 Category

F - 0000 Medical Programs

G - 0000 Application Processing

H - 0000 Eligibility Determinations

• H - 100 General Information
• H - 600 Extended Medicaid
• H - 700 SSI Retroactive Medicaid
• H - 800 Long Term Care
• H - 900 Home and Community Based Services (HCBS)
• H - 1000 Medically Needy Program - General Information
  
  • H - 1020 Regular and Spend-Down Medically Needy - MAGI Related
  • H - 1030 Spend-Down Medically Needy - SSI Related
  • H - 1040 Spend-Down Medically Needy - Long Term Care - SSI Related
  • H - 1050 Spend-Down Medically Needy - Home and Community Based Services - SSI Related
  • H - 1060 Reserved
• H - 1100 Qualified Medicare Beneficiary (QMB)
• H - 1200 Qualified Disabled and Working Individuals (QDWI)
• H - 1300 Specified Low-Income Medicare Beneficiary (SLMB)
• H - 1400 Breast and Cervical Cancer Program
• H - 1500 Continued Medicaid
• H - 1600 Tuberculosis Infected (TB)
• H - 1800 Retroactive Medical Eligibility (RME)
• H - 1900 Twelve (12) Months Continuous Eligibility
• H - 2000 Qualifying Individuals Program (QI)
• H - 2100 Medicaid Purchase Plan (MPP)
• H - 2200 Reserved
• H - 2300 Family Opportunity Act Medicaid Program
• H - 2400 Refugee Medical Assistance
• H - 2500 Youth Aging Out of Foster Care
• H - 2600 Reserved
• H - 2700 Reserved
• H - 2800 Parents and Caretaker Relatives
• H - 2900 MAGI Pregnant Women
• H- 3000 MAGI Children 
  
  • H - 3010 Children Under Age 19 Group - Deemed Newborn Children
  • H - 3020 CHAMP
  • H - 3030 LaCHIP
  • H - 3040 LaCHIP Affordable Plan 
  • H - 3050 LaCHIP Phase IV
• H - 3100 Former Foster Care Children
• H - 3200 Hospital Presumptive Eligibility (HPE)
• H - 3300 Provisional Medicaid
• H - 3400 Take Charge Plus
• H - 3500 Adult Group
• H - 3600 Program of All Inclusive Care for the Elderly (PACE)
• H - 3700 COVID-19 Uninsured Eligibility
• H - 3800 Act 421 Children's Medicaid Option (TEFRA)
• H - 3900 Louisiana Health Insurance Premium Payment Program (LaHIPP)

I - 0000 Eligibility Factors

• I - 100 Age - MAGI Related
• I - 200 Assignment of Third Party Rights
• I - 300 Citizenship / Identity and Qualified Non-Citizen Status
• I - 400 Continuity of Stay (LTC Only, Except HCBS)
• I - 500 Deprivation
• I - 600 Enumeration
• I - 700 Reserved
• I - 800 Home
• I - 900 Institutionalization
• I - 1000 Medical Certification
• I - 1100 Medicare Ineligibility
• I - 1200 Mother's Medicaid Eligibility (Deemed Newborn Children)
• I - 1300 Reserved
• I - 1400 Need - General Information
• I - 1500 Need - Income
  
  • I - 1530 Need - SSI-Related Income
  • I - 1540 Reserved
  • I - 1550 MAGI Determinations
• I - 1600 Need - Resources - General Information
  
  • I - 1620 Long-Term Care Partnership (LTCP) Program
  • I - 1630 Need - SSI-Related Resources
  • I - 1660 Spousal Impoverishment Resource Provisions (LTC/HCBS)
  • I - 1670 Transfer of Assets For Less Than Fair Market Value
  • I - 1680 Reserved
• I - 1700 Trusts
• I - 1800 Reserved
• I - 1900 Residence
• I - 2000 Support Enforcement Services
• I - 2100 Supplemental Security Income (SSI) Eligibility
• I - 2200 Creditable Health Insurance

J - 0000 Medicaid Eligibility Cards and Optional State Supplement Payments

K - 0000 Renewals

L - 0000 Changes

M - 0000 Reserved

N - 0000 Special Processing

O - 0000 Reserved

P - 0000 Third Party Liability (TPL)

Q - 0000 Inquiries and Complaints

R - 0000 Authorized Representation

S - 0000 Verification and Documentation

T - 0000 Fair Hearings

U - 0000 Fraud and Recovery

V - 0000 Reserved

W - 0000 Reserved

X - 0000 Retirees

Y - 0000 Reserved

Z - 0000 Charts

• Z - 100 Maximum SSI Student Child Earned Income Exclusion Amounts
• Z - 200 Federal Poverty Income Guidelines
• Z - 300 Medically Needy Income Eligibility Standards (MNIES)
• Z - 400 Federal Benefit Rate (FBR)
• Z - 500 Filing Requirements for Children and Tax Dependents
• Z - 700 LTC/HCBS SIL Rate, Resource Limits and Personal Care Needs Allowance
• Z - 800 Spousal Impoverishment Maintenance Needs and Resource Standards
• Z - 900 Resource Limits by Program
• Z - 1000 Reserved
• Z - 1100 Reserved
• Z - 1200 Life Expectancy Tables
• Z - 1300 Usufruct and Remainder Interest Tables
• Z - 1400 Social Security Cost of Living Adjustment (COLA) Extended Medicaid Only
• Z - 1500 Deeming Allowance
• Z - 1700 Reserved
• Z - 1800 SSI Disability Denial Codes
• Z - 2200 Medicare Savings Program Resource Limits
• Z - 2300 Home Equity Limits by Year
• Z - 2400 Average Projected Rates For MNP By Program
• Z - 2500 Premium Program Income Limits

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