Louisiana Medicaid is implementing changes to the way it determines the amount Medicaid members must pay for their long-term care (LTC) healthcare services. This will include changes to timelines for reporting and calculations that may impact members and providers.
Louisiana Medicaid provides coverage for LTC healthcare services for eligible members in nursing facilities and home and community-based settings. In many cases, members are required to cover a portion of the cost that Medicaid does not pay. This amount is known as patient liability income (PLI) and is owed to the provider who delivers the care.
Medicaid looks at money coming in (income) and money going out (expenses) to figure out how much a member might owe for their care. Currently, Louisiana Medicaid calculates and imposes PLI in the month income was received and expenses were incurred. This causes retroactive adjustments to provider claims. The new process, which will be implemented starting in August 2024, will impose PLI changes in future months to comply with federal advance notice requirements. Medicaid conducted webinars in July to train providers and prepare them for the process changes.
Under the new PLI process, Louisiana Medicaid will consider income received and expenses incurred in the three months prior to the month the changes are reported. All income and expense changes will result in an adjustment to the member’s future PLI, to account for any underpayments or overpayments in prior months (up to three months prior to the reporting month). Underpayments will be added to, and overpayments will be subtracted from, a member’s future PLI.
Additionally, eligibility decision notices and PLI notices will be two separate notices following implementation of the new process. PLI notices will include the member’s PLI for the next three months. Members will receive at least one PLI notice a quarter. Louisiana Medicaid will continue to send a copy of eligibility decision notices and PLI notices to the relevant providers.
Louisiana Medicaid LTC members, applicants and providers can submit questions through an online form at www.ldh.la.gov/page/contact-us-long-term-care. Louisiana Medicaid members with questions or information updates may also contact the Louisiana Medicaid Long-Term Care Customer Service Unit by phone, toll-free, at 1-800-230-0690, or by email at LALTC.processingcenter@la.gov.
LTC providers should reach out to their assigned Louisiana Medicaid analyst. If they are unsure how to reach their analyst, they may call the toll free number for assistance. Additional provider information, including a recording of the provider training, is also available online at https://ldh.la.gov/page/5074.