reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 11 - Express Lane Eligibility › Section III-1103 - Eligibility Determinations

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  department shall rely on the findings from an Express Lane agency to satisfy
				  one or more of the eligibility components (regardless of any differences in the
				  income budget unit, disregards, deeming of income or other methodologies)
				  required to make an eligibility determination.
1. An Express Lane agency is a public agency
				  that is determined by the department to be capable of making the determinations
				  of one or more of the eligibility requirements defined in the Medicaid State
				  Plan. Express Lane agencies are need-based programs/agencies.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 11 - Express Lane Eligibility › Section III-1105 - Automatic Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  department may initiate and determine Medicaid eligibility based on data from
				  sources other than the child (or the child's family) without an application
				  form; however, a child can only be automatically enrolled for coverage if the:
1. child or family consents to being enrolled
				  through affirmation and signature on an Express Lane agency application;
				  and
2. department has informed the
				  parent, guardian or custodial relative of the:
a. services that will be covered;
b. appropriate methods for using such
				  services;
c. premium or other
				  cost-sharing charges that apply (if applicable);
d. medical support obligations created by
				  enrollment (if applicable); and
e.
				  actions the parent, guardian or relative must take to maintain enrollment and
				  renew coverage.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 1 - General Administration › Chapter 11 - Express Lane Eligibility › Section III-1107 - Disclosure of Eligibility Data

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Notwithstanding any other provisions of law, Express Lane agencies in
				  possession of data directly relevant to Express Lane eligibility determinations
				  shall convey such data to the department and shall ensure that the individual
				  (or his parent, guardian, caretaker relative, authorized representative) whose
				  circumstances are described in the data has either provided consent to
				  disclosure, or has not objected to disclosure.
1. Such individuals shall be provided with
				  advance notice of disclosure and a reasonable opportunity to object to the
				  disclosure of their information.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2303 - Family Opportunity Act Medicaid Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Family Opportunity Act, signed into
				  law by Congress as part of the Deficit Reduction Act of 2005, allows states to
				  offer a Medicaid buy-in program to families with income up to 300 percent of
				  the federal poverty level (FPL) for children with disabilities who are not
				  eligible for Supplemental Security income (SSI) disability benefits due to
				  excess income or resources. The department hereby implements a Medicaid buy-in
				  program called the Family Opportunity Act Medicaid Program to provide Medicaid
				  coverage to children with disabilities.
B. Eligibility Requirements. Children born on
				  or after October 1, 1989, up to age 19, and who meet the following requirements
				  may receive health care coverage through the Family Opportunity Act Medicaid
				  Program.
1. The child must have a disability
				  which meets the Social Security administration's childhood disability
				  criteria.
2. Gross family income
				  must not be more than 300 percent of the federal poverty level using the income
				  methodologies of the SSI program.
a. For the
				  purpose of determining family income, the family unit shall consist of the
				  following members:
i. child(ren) with
				  disabilities;
ii. natural or legal
				  parent(s); and
iii. siblings under
				  age 19.
b. Step-parents
				  and step-siblings are excluded from the income determination.
3. The child may be uninsured or
				  underinsured.
a. Parents are required to
				  enroll in available employer-sponsored health plans when the employer
				  contributes at least 50 percent of the annual premium costs. Participation in
				  such employer-sponsored health plans is a condition of continuing Medicaid
				  coverage.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2305 - Provisional Medicaid Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  Provisional Medicaid Program provides Medicaid-only coverage to individuals
				  who:
1. are aged or have a disability;
				  and
2. meet income and resource
				  requirements for supplemental security income (SSI) cash assistance.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2307 - Youth Aging Out of Foster Care

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Pursuant to section 477 of the Foster Care Independence Act of 1999
				  (Public Law
				  106-169) and Act 352 of the 2008 Regular Session
				  of the Louisiana Legislature, the Department of Health and Hospitals hereby
				  implements a Medicaid eligibility group, effective March 1, 2009, to provide
				  health care coverage to youth who are transitioning out of foster care to
				  self-sufficiency upon reaching age 18. This eligibility group will be called
				  youth aging out of foster care.
B.
				  Eligibility Requirements. Youth who are aging out of foster care on or after
				  March 1, 2009 and meet all of the following requirements may receive Medicaid
				  health care coverage under this new eligibility group.
1. The youth must be from age 18 up to age
				  21.
2. The youth must have been in
				  foster care and in state custody, either in Louisiana or another state, upon
				  obtaining age 18.
3. The youth must
				  live in Louisiana.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2308 - Former Foster Care Children Group

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Pursuant to the Patient Protection and Affordable Care Act of 2010
				  (collectively referred to as the Affordable Care Act), the Department of Health
				  implemented a Medicaid eligibility group, effective December 31, 2013, to
				  provide health care coverage to youth who are transitioning out of foster care
				  to self-sufficiency upon reaching age 18 or at a higher age selected by the
				  department. This eligibility group is called former foster care children
				  group.
B. Eligibility Requirements
1. For youth who turned age 18 prior to
				  January 1, 2023, the youth must meet all of the following requirements to
				  receive Medicaid health care coverage under this eligibility group:
a. be from age 18 to 26 years old;
b. is not eligible or enrolled in another
				  mandatory eligibility group described in sections 1902(a)(10)(A)(i)(I)-(VII) of
				  the Social Security Act;
c. was in
				  foster care under Louisiana's custody and receiving Medicaid upon turning age
				  18 or upon aging out of foster care at a higher age elected by the state in its
				  title IV- E plan (up to age 21); and
d. resides in Louisiana.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2309 - Medicaid Purchase Plan [Formerly LAC 50:III.763-765]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective January 1, 2004, the Department
				  of Health and Hospitals, Office of the Secretary, Bureau of Health Services
				  Financing implemented the Medicaid Purchase Plan Program for workers with
				  disabilities under title XIX of the Social Security Act. The Medicaid Purchase
				  Plan allows persons who meet the Social Security disability criteria to seek
				  the employment services, vocational rehabilitation services, and other support
				  services needed to obtain, regain or maintain employment, and reduce their
				  independence on cash benefit programs.
B. Recipient Eligibility. Effective January
				  1, 2014, the Medicaid purchase plan shall cover workers with disabilities who
				  meet the following criteria:
1. are
				  employed;
2. are age 16 through age
				  64;
3. meet the Social Security
				  Administration criteria for disability;
4. have net income less than 100 percent of
				  the federal poverty level;
5. have
				  countable resources (assets) less than $10,000;
a. all life insurance policies, medical
				  savings accounts, and retirement accounts shall be counted towards the resource
				  limit; and
6. are
				  enrolled in no-cost health insurance.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2311 - Programs Louisiana Health Insurance Premium Payment Program

Current through Register Vol. 50, No. 6, June 20, 2024
A.Section 1906 of
				  Title XIX of the Social Security Act mandates that Medicaid recipients enroll,
				  and maintain their enrollment, in cost-effective group health insurance plans
				  as a condition of Medicaid eligibility if such a plan is available. In
				  compliance with section 1906, the department hereby establishes the Louisiana
				  Health Insurance Premium Payment (LaHIPP) Program to provide Medicaid payment
				  of the costs associated with the enrollment of recipients in cost-effective
				  group health insurance plans.
B.
				  Medicaid recipients shall be enrolled in LaHIPP when cost-effective health
				  plans are available through the recipient's employer or a responsible party's
				  employer-based health plan if the recipient is enrolled or eligible for such a
				  health plan.
1. The enrollment period for the
				  LaHIPP Program shall be no less than six months.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2313 - Medically Needy Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  Medically Needy Program (MNP) provides Medicaid coverage when an individual's
				  or family's income and/or resources are sufficient to meet basic needs in a
				  categorical assistance program, but not sufficient to meet medical needs
				  according to the MNP standards.
1. The income
				  standard used in the MNP is the federal medically needy income eligibility
				  standard (MNIES).
2. Resources are
				  not applicable to modified adjusted gross income (MAGI) related MNP
				  cases.
3. MNP eligibility cannot be
				  considered prior to establishing income ineligibility in a categorically
				  related assistance group.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2315 - LaMOMS Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				  the provisions of the Omnibus Budget Reconciliation Act of 1986, the Department
				  of Health, Bureau of Health Services Financing shall provide health care
				  coverage through the LaMOMS Program to Medicaid eligible pregnant women with
				  low income under the Medicaid state plan.
B. Eligibility Requirements. Eligibility for
				  LaMOMS coverage may begin at any time during a pregnancy, and as early as three
				  months prior to the month of application. Eligibility cannot begin before the
				  first month of pregnancy. The pregnant woman must be pregnant for each month of
				  eligibility, except for the 12-month postpartum period.
C. Financial Eligibility. Effective January
				  1, 2014, the LaMOMS Program shall provide Medicaid coverage to pregnant women
				  with family income up to 133 percent of the federal poverty level. For
				  applicants with income above 133 percent of the federal poverty level, 5
				  percent of the federal poverty level shall be disregarded from their income.
1. Changes in income shall be disregarded
				  during the period of pregnancy and for the 12-month postpartum
				  period.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2317 - New Adult Eligibility Group

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Pursuant to the Patient Protection and Affordable Care Act (PL. No. 111-148),
				  hereafter referred to as the Affordable Care Act (ACA), and §1937 of title XIX
				  of the Social Security Act, the department will expand Medicaid coverage to a
				  targeted new eligibility group, hereafter referred to as the new adult
				  group.
B. Effective July 1, 2016,
				  the department will establish a new Medicaid eligibility category for the new
				  adult group, as defined in §1905(y)(2)(A) of title XIX of the Social Security
				  Act.
C. Eligibility Requirements.
				  Coverage in the new adult group will be provided to individuals with household
				  income up to 133 percent of the federal poverty level with a 5 percent income
				  disregard who are:
1. from age 19 to 65 years
				  old;
2. not pregnant;
3. not entitled to, or enrolled in Medicare
				  Part A or Medicare Part B;
4. not
				  otherwise eligible for and enrolled in mandatory coverage under the Medicaid
				  State Plan;
a. parents, children or disabled
				  persons receiving Supplemental Security Income (SSI) benefits are excluded from
				  enrollment as a new adult; and
5. parents or other caretaker relatives
				  living with a dependent child(ren) under age 19 who are receiving benefits
				  under Medicaid, the Childrens Health Insurance Program, or otherwise enrolled
				  in minimum essential coverage as defined in
				  42 CFR
				  435.4.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2325 - Medicare Savings Programs

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Medical assistance furnished to qualified Medicare beneficiaries (QMB),
				  specified low income beneficiaries (SLMB) and qualified individuals (QI) is
				  commonly referred to as the Medicare Savings Programs (MSP). Medicaid coverage
				  under these programs is limited to payment of Medicare premiums, and may pay
				  deductibles and co-insurance.
1. Effective
				  January 1, 2010, with the consent of an individual completing an application
				  for low income subsidy (LIS) benefits, the Social Security Administration will
				  transmit LIS data to Medicaid.
2.
				  Medicaid shall use the data to initiate an application for the individual for
				  benefits under the Medicare Savings Program.
3. The date that the LIS application is filed
				  with the Social Security Administration will be used as the date of application
				  for MSP and for determining the effective date of MSP eligibility.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2327 - Modified Adjusted Gross Income (MAGI) Groups

Current through Register Vol. 50, No. 6, June 20, 2024
A. For eligibility determinations effective
				  December 31, 2013 eligibility shall be determined by modified adjusted gross
				  income (MAGI) methodology in accordance with section 1004(a)(2) of the Patient
				  Protection and Affordable Care Act (ACA) of 2010 and section 36B(d)(2)(B) of
				  the
Internal Revenue Code
, for the following groups:
1. parents and caretaker relatives group
				  which includes adult individuals formerly considered for low income families
				  with children as parents or caretaker relatives;
2. pregnant women;
3. child related groups; and
4. other adult related groups including
				  breast and cervical cancer, tuberculosis (TB) and family planning.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2329 - Lawfully Resident Children

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  The Childrens Health Insurance Program Reauthorization Act (CHIPRA) of 2009,
				  Public Law No. 111-3, established provisions which allow states the option of
				  providing Medicaid and Childrens Health Insurance Program (CHIP) coverage to
				  children up to age 19 who are lawfully residing in the United States, including
				  those within their first five years of having certain legal status.
B. The department shall utilize the CHIPRA
				  Option under P.L.
				  111-3 provisions for the enrollment of children,
				  up to age 19, who are lawfully residing in the United States.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2330 - Twelve-Months Postpartum Medicaid Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to the provisions of the section
				  9812 of the American Rescue Plan Act of 2021, the Department of Health, Bureau
				  of Health Services Financing shall provide, during a five year period beginning
				  April 1, 2022, that an individual who, while pregnant, is eligible for and has
				  received medical assistance under the state plan or waiver of such plan
				  including during a period of retroactive eligibility, shall remain eligible for
				  a 12-month postpartum period. The 12-month postpartum period begins on the last
				  day of pregnancy and ends on the last day of the month in which the 12-month
				  postpartum period has expired.
B.
				  The medical assistance provided for the pregnant or postpartum individual
				  shall:
1. include all items and services
				  covered under the state plan (or waiver) that are not less in amount, duration,
				  or scope to the medical assistance available for an individual described in
				  section 1902(a(10)(A)(i)of the Social Security Act; and
2. be provided for the individual while
				  pregnant and during the 12-month period that begins on the last day of the
				  individual's pregnancy and ends on the last day of the month in which such
				  12-month period ends.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 23 - Eligibility Groups and Medicaid Programs › Section III-2331 - Act 421 Children's Medicaid Option (Act 421-CMO/TEFRA)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
				  section 1902(e)(3) of the Social Security Act the state may extend Medicaid
				  eligibility to certain children living in the community, who require the level
				  of care provided in an institution, and who would be eligible for Medicaid if
				  living in an institution.
1. - 2.
				  Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 25 - Eligibility Factors › Section III-2523 - Citizenship

Current through Register Vol. 50, No. 6, June 20, 2024
A. Qualified
				  Non-Citizens
1. The department hereby adopts
				  criteria for the coverage of qualified non-citizens pursuant to the provisions
				  of §401 of the Personal and Work Opportunity Act of 1996 (P.L. 104-193) as
				  amended by the Balanced Budget Act of 1997 (P.L. 105-33).
2. The department elects to provide regular
				  Medicaid coverage to optional qualified non-citizens who were in the United
				  States prior to August 22, 1996, who meet all eligibility criteria.
3. Qualified non-citizens entering the United
				  States on or after August 22, 1996 are not eligible for Medicaid coverage for
				  five years after entry into the United States.
a. Such qualified non-citizens are eligible
				  for emergency services only.
b.
				  Upon expiration of the five-year period, coverage for regular Medicaid services
				  shall be considered if the qualified non-citizen meets all eligibility
				  criteria.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 25 - Eligibility Factors › Section III-2525 - Twelve-Month Continuous Eligibility

Current through Register Vol. 50, No. 6, June 20, 2024
A. Act 128 of the First Extraordinary Session
				  of the 1998 Louisiana Legislature authorized the Department to adopt the
				  guaranteed eligibility option for children, pursuant to §4731 of the Balanced
				  Budget Act (BBA) of 1997. These provisions allow states to guarantee Medicaid
				  eligibility for children, under age 19, for up to 12 months from the date of
				  determination.
B. Children who are
				  under age 19 and certified in a child-related or family-related category of
				  assistance are entitled to 12 months of continuous Medicaid eligibility as long
				  as eligibility does not extend beyond the child's nineteenth
				  birthday.
C. A child's eligibility
				  may not be terminated during a continuous eligibility period, regardless of any
				  changes in circumstances, unless the child meets an exception set forth in
				  42 CFR
				  435.926(d) or
				  42 CFR
				  457.342.
1.
				  - 6. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 3 - Eligibility Groups and Factors › Chapter 25 - Eligibility Factors › Section III-2529 - Hospital Presumptive Eligibility

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective December 31, 2013 any hospital
				  designated by Louisiana Medicaid as a hospital presumptive eligibility
				  qualified provider (HPEQP) may obtain information and determine hospital
				  presumptive eligibility (HPE) for individuals who are not currently enrolled in
				  Medicaid and who are in need of medical services covered under the state plan.
1. Coverage groups eligible to be considered
				  for hospital presumptive eligibility include:
a. parents and caretaker relatives;
b. pregnant women;
c. children under age 19;
d. former foster care children;
e. family planning; and
f. certain individuals needing treatment for
				  breast or cervical cancer.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 5 - Financial Eligibility › Chapter 103 - Income › Section III-10305 - Income Disregards

Current through Register Vol. 50, No. 6, June 20, 2024
A. For
				  recipients in the Family Opportunity Act Medicaid Program, an income disregard
				  of $85 will be applied to total gross (earned and unearned) family income and
				  then half of the remaining income will be disregarded.
B. During the eligibility determination
				  process for home and community-based services, an individual shall be
				  considered eligible under the Medicaid State Plan as though the individual was
				  a resident in a nursing facility or intermediate care facility for persons with
				  developmental disabilities (ICF/DD) and an income disregard shall be applied to
				  gross income over the special income level.
1. The special income level used to determine
				  financial eligibility for long-term care services (nursing facility, ICF/DD,
				  and home and community-based services) is three times the Supplemental Security
				  Income federal benefit rate.
2.
				  Gross income may exceed the special income level but cannot be more than the
				  highest Medicaid facility rate (nursing or ICF/DD, as applicable) in the state
				  at the time of application for home and community-based services.
3. Income disregarded in the initial
				  eligibility determination process will not be disregarded in the
				  post-eligibility process for determining contributions toward the cost of
				  care.
4. The personal care needs
				  amount (the amount of income protected to cover the expense of living in the
				  community) remains capped at the special income level.
5. All income over the special income level
				  shall be contributed towards the cost of care.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 5 - Financial Eligibility › Chapter 103 - Income › Section III-10307 - Modified Adjusted Gross Income (MAGI) Groups

Current through Register Vol. 50, No. 6, June 20, 2024
A. MAGI-based
1. Income shall be calculated in accordance
				  with
				  42 CFR §
												435.603 and §
											457.315.
2. - 29.z.ii. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 5 - Financial Eligibility › Chapter 107 - Resources › Section III-10703 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medicaid
				  utilizes the income and asset methodologies of the Supplemental Security Income
				  (SSI) Program to determine Medicaid eligibility for aged, blind and disabled
				  individuals.
B. Under Section
				  1902(r)(2) of the Social Security Act, states are allowed to use less
				  restrictive income and asset methodologies in determining eligibility for most
				  Medicaid eligibility groups than are used by the cash assistance
				  program.
C. The following
				  individuals resources shall be considered in determining eligibility for the
				  Qualified Disabled and Working Individual (QDWI) Program:
1. the applicant/recipient; and
a. - b. Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 5 - Financial Eligibility › Chapter 107 - Resources › Section III-10705 - Resource Disregards

Current through Register Vol. 50, No. 6, June 20, 2024
A. In
				  compliance with the Deficit Reduction Act, individuals who are insured under a
				  long-term care insurance policy that meets the requirements of a "qualified
				  state long-term care insurance partnership" policy shall receive a disregard of
				  resources equal to the amount paid under the insurance policy.
1. The Medicaid Program shall accept the
				  certification of the Louisiana Commissioner of Insurance that the long-term
				  care policy meets the requirements of a "qualified long-term care insurance
				  partnership" policy.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 5 - Financial Eligibility › Chapter 107 - Resources › Section III-10717 - Types of SSI-Related Resources

Current through Register Vol. 50, No. 6, June 20, 2024
A. The following SSI-related resources are
				  considered in determining eligibility for Medicaid coverage.
1. Annuities
a. Any annuity purchases must adhere to the
				  following requirements or the annuity will be considered an available countable
				  resource.
i. The annuity must contain a
				  statement that names the state of Louisiana as the remainder beneficiary in the
				  first position for the total amount of Medicaid assistance paid on behalf of
				  the annuitant unless there is a community spouse and/or a minor or disabled
				  child.
ii. If there is a community
				  spouse and/or a minor or disabled child, the state may be named in the next
				  position after those individuals. If the state has been named after a community
				  spouse and/or minor or disabled child and any of those individuals or their
				  representatives dispose of any of the remainder of the annuity for less than
				  fair market value, the state may then be named in the first position.
iii. If the state is not named as a remainder
				  beneficiary in the correct position, the purchase of the annuity will be
				  considered a transfer for less than fair market value. The full purchase value
				  of the annuity will be considered the amount transferred.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 5 - Financial Eligibility › Chapter 109 - Transfers of Assets › Section III-10905 - Transfers

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Deficit
				  Reduction Act of 2005 established new provisions governing the treatment of
				  transfers of assets for individuals and their spouses who apply for or receive
				  long-term care services.
B. The
				  look-back period is lengthened to five years for potential transfers of
				  assets.
C. For transfers of assets
				  for less than fair market value, the period of ineligibility for an individual
				  in a long term care facility begins the later of the first day of the month
				  after which the asset was transferred for less than fair market value or the
				  date on which the individual is eligible for Medicaid and is receiving
				  institutional level of care services (based on an approved application for such
				  services) that, but for the imposition of the penalty, would be covered by
				  Medicaid.
1. Periods of ineligibility cannot
				  occur during any other period of ineligibility; they must be consecutive and
				  not concurrent.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 9 - Long-Term Care Eligibility › Chapter 161 - General Provisions › Section III-16101 - Spousal Impoverishment

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Spousal impoverishment provisions assure that the needs of an institutionalized
				  individual's legal spouse and/or dependents that reside in the community
				  continue to be met.
B. Spousal
				  impoverishment resource provisions allow certain long term care
				  applicants/recipients residing in a medical institution for a continuous period
				  of institutionalization or home and community-based services waiver
				  applicants/recipients to allocate resources to a legal spouse (referred to as
				  the community spouse) who lives in a non-institutionalized living arrangement
				  for the community spouse's own use and maintenance.
1. Exception. The spousal impoverishment
				  provisions do not apply to individuals residing in a group home.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 9 - Long-Term Care Eligibility › Chapter 161 - General Provisions › Section III-16103 - Nursing Facility Private-Pay Cost

Current through Register Vol. 50, No. 6, June 20, 2024
A. The department uses a statewide average,
				  monthly private-pay nursing facility cost amount to calculate the periods of
				  ineligibility for long-term care services when uncompensated transfers of
				  assets occur. The average, monthly private-pay nursing facility cost amount
				  shall be determined by the bureau.
1. The
				  amount will be reviewed annually to ensure that it remains aligned with
				  private-pay costs.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 201 - Louisiana Children's Health Insurance Program (LaCHIP)-Phases 1-3 › Section III-20101 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.Section
				  4901 of the Balanced Budget Act of 1997,
				  Public Law
				  105-33, established provisions under Title XXI of
				  the Social Security Act to provide health insurance coverage to uninsured,
				  low-income children through an expansion of existing Medicaid Programs,
				  creation of stand-alone programs, or a combination of both. The department
				  implemented the provisions of Title XXI as a Medicaid expansion program called
				  the Louisiana Children's Health Insurance Program (LaCHIP).
B. Effective October 20, 1998, the department
				  implemented phase one of LaCHIP which provides coverage to uninsured children
				  with family income up to 133 percent of the federal poverty level.
C. Effective October 1, 1999, the department
				  implemented phase two of LaCHIP which provides coverage to uninsured children
				  with family income between 133 and 150 percent of the federal poverty
				  level.
D. Effective January 1,
				  2001, the department implemented phase three of LaCHIP which provides coverage
				  to uninsured children with family income up to 200 percent of the federal
				  poverty level.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XXI of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 201 - Louisiana Children's Health Insurance Program (LaCHIP)-Phases 1-3 › Section III-20103 - Eligibility Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. The LaCHIP
				  Medicaid program provides health insurance coverage to low-income, uninsured
				  children who meet the following criteria:
1.
				  are under the age of 19;
2. are
				  from families with income at or below 217 percent of the federal poverty level;
				  and
3. do not meet the state's
				  Medicaid eligibility criteria in effect as of March 31, 1997.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 203 - LaCHIP Phase IV-Prenatal Care Services › Section III-20301 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective May 1, 2007, the Department of Health and Hospitals provides State
				  Children's Health Insurance Program (SCHIP) coverage of prenatal care services
				  to low income, non-citizen women as an expansion of coverage for children under
				  Title XXI of the Social Security Act. SCHIP coverage of prenatal care services
				  will be an expansion of coverage for children, from conception to birth, with
				  income from 0 percent through 200 percent of the federal poverty level
				  (FPL).
B. Effective December 31,
				  2013, coverage of SCHIP prenatal care services shall be expanded to include any
				  pregnant woman with income between 138 percent and 214 percent of the
				  FPL.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XXI of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 203 - LaCHIP Phase IV-Prenatal Care Services › Section III-20303 - Eligibility Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. An applicant
				  must be a Louisiana resident and cannot be eligible for Medicaid benefits under
				  the provisions of Title XIX of the Social Security Act.
B. Applicants must be uninsured at the time
				  of application.
1. Applicants are considered
				  to be uninsured if they do not have creditable health insurance that provides
				  coverage of prenatal care services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 203 - LaCHIP Phase IV-Prenatal Care Services › Section III-20305 - Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Covered
				  Services. Recipients shall receive coverage of pregnancy-related health care
				  services and associated medically necessary services for conditions that, if
				  not treated, would complicate the pregnancy. Pregnancy-related health care
				  services which may be covered include:
1.
				  inpatient and outpatient health care services;
2. physician services;
3. surgical services;
4. clinic and other ambulatory health care
				  services;
5. prescription and
				  over-the-counter medications;
6.
				  laboratory and radiological services;
7. pre-natal care and pre-pregnancy family
				  services and supplies;
8. inpatient
				  and outpatient mental health services other than those services relative to
				  substance abuse treatment;
9.
				  durable medical equipment and other medically-related or remedial
				  devices;
10. disposable medical
				  supplies;
11. nursing care
				  services;
12. case management
				  services;
13. physical therapy,
				  occupational therapy and services for individuals with speech, hearing and
				  language disorders;
14. medical
				  transportation services; and
15.
				  any other medically necessary medical, diagnostic, screening, preventive,
				  restorative, remedial, therapeutic or rehabilitative services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 205 - Louisiana Children's Health Insurance Program (LaCHIP)-Phase V › Section III-20501 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective April 1, 2008, the Department implements phase five of LaCHIP as a
				  stand-alone program under the provisions of title XXI of the Social Security
				  Act to provide coverage to uninsured children with family income from 200
				  percent up to 250 percent of the federal poverty level.
B. The department retains the oversight and
				  management of this LaCHIP expansion with health care benefits provided through
				  the BAYOU HEALTH Program and behavioral health services provided through the
				  Louisiana behavioral health partnership (LBHP).
C. Phase five is a cost-sharing program.
				  Families who are enrolled in phase five of LaCHIP will be responsible for
				  paying premiums.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XXI of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 205 - Louisiana Children's Health Insurance Program (LaCHIP)-Phase V › Section III-20503 - Eligibility Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. This LaCHIP
				  stand-alone program provides health care coverage to uninsured children who
				  meet the following criteria:
1. are under the
				  age of 19;
2. have family income
				  from 200 percent up to 250 percent of the federal poverty level
3. do not have creditable health insurance
				  coverage; and
4. are not eligible
				  for any other Medicaid program.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 205 - Louisiana Children's Health Insurance Program (LaCHIP)-Phase V › Section III-20505 - Covered Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Children
				  covered in phase five of the LaCHIP expansion shall receive health care
				  benefits through an array of covered services offered by health plans
				  participating in the BAYOU HEALTH Program, and behavioral health services
				  administered by the statewide management organization under the LBHP. The
				  following services shall be included:
1.
				  inpatient hospital services:
a.
				  pre-certification is required for hospital admissions. Emergency services are
				  covered if, upon review, presentation is determined to be life-threatening,
				  resulting in admission to inpatient, partial hospital or intensive outpatient
				  level of care;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 205 - Louisiana Children's Health Insurance Program (LaCHIP)-Phase V › Section III-20507 - Cost Sharing

Current through Register Vol. 50, No. 6, June 20, 2024
A. Phase five
				  of LaCHIP is a cost-sharing program with premiums limited to no more than 5
				  percent of the familys annual income.
B
				  . The following cost-sharing criteria shall apply.
1. Premiums. When family income is between
				  201 percent and 250 percent of the federal poverty level, families shall be
				  responsible for paying a $50 per month premium.
a. Premiums are due by the first of each
				  month. If payment is not received by the tenth of the month, the responsible
				  party shall be notified that coverage may be terminated if payment is not
				  received by the twenty-first of the month.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part III - Eligibility › Subpart 11 - State Children's Health Insurance Program › Chapter 205 - Louisiana Children's Health Insurance Program (LaCHIP)-Phase V › Section III-20509 - Dental Services Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. Services covered in the LaCHIP Affordable
				  Plan Dental Program shall be reimbursed at the lower of either:
1. the dentist's billed charges minus any
				  third party coverage; or
2. the
				  state's established schedule of fees, which is developed in consultation with
				  the Louisiana Dental Association and the Medicaid dental consultants, minus any
				  third party coverage.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 1 - General Provisions › Section V-107 - Elective Deliveries

Current through Register Vol. 50, No. 6, June 20, 2024
A. Induced
				  deliveries and cesarean sections shall not be reimbursed when performed prior
				  to 39 weeks gestation. This shall not apply to deliveries when there is a
				  documented medical condition that would justify delivery prior to 39 weeks
				  gestation.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 1 - General Provisions › Section V-109 - Healthcare-Acquired and Provider Preventable Conditions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
				  July 1, 2012, the Medicaid Program will not provide reimbursement for
				  healthcare-acquired or provider preventable conditions which result in medical
				  procedures performed in error and have a serious, adverse impact to the health
				  of the Medicaid recipient.
B.
				  Reimbursement shall not be provided for the following healthcare-acquired
				  conditions (for any inpatient hospital settings participating in the Medicaid
				  Program) including:
1. foreign object
				  retained after surgery;
2. air
				  embolism;
3. blood
				  incompatibility;
4. stage III and
				  IV pressure ulcers;
5. falls and
				  trauma, including:
a. fractures;
b. dislocations;
c. intracranial injuries;
d. crushing injuries;
e. burns; or
f. electric shock;
6. catheter-associated urinary tract
				  infection (UTI);
7. vascular
				  catheter-associated infection;
8.
				  manifestations of poor clycemic control, including:
a. iabetic ketoacidosis;
b. nonketotic hyperosmolar coma;
c. hypoglycemic coma;
d. secondary siabetes with ketoacidosis;
				  or
e. secondary diabetes with
				  hyperosmolarity;
9.
				  surgical site infection following:
a. coronary
				  artery bypass graft (CABG)-mediastinitis;
b. bariatric surgery, including:
i. laparoscopic gastric bypass;
ii. gastroenterostomy; or
iii. laparoscopic gastric restrictive
				  surgery; or
c.
				  orthopedic procedures, including:
i.
				  spine;
ii. neck;
iii. shoulder; or
iv. elbow; or
10. deep vein thrombosis (DVT)/pulmonary
				  embolism (PE) following total knee replacement or hip replacement with
				  pediatric and obstetric exceptions.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 1 - General Provisions › Section V-111 - Coverage of Donor Human Breast Milk

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  The Medicaid Program shall provide reimbursement to acute care hospitals for
				  donor human breast milk provided to hospitalized infants.
B. Reimbursement. Hospitals shall be
				  reimbursed for donor human breast milk when obtained from a member bank of the
				  Human Milk Banking Association of North America. Reimbursement will be made as
				  an add-on service in addition to the hospital payment for the inpatient
				  hospital stay.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 1 - General Provisions › Section V-113 - Coverage of Long-Acting Reversible Contraceptives

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Medicaid Program shall provide
				  reimbursement to acute care hospitals for long-acting reversible contraceptives
				  (LARCs) provided to women immediately following childbirth and during the
				  hospital stay.
B. Reimbursement.
				  Hospitals shall be reimbursed for LARCs as an add-on service in addition to
				  their daily per diem rate for the inpatient hospital stay.
1. Physicians/professional practitioners who
				  insert the device will also be reimbursed an insertion fee in accordance with
				  the reimbursement rates established for this service in the Professional
				  Services Program.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 1 - General Provisions › Section V-115 - Office of Public Health Newborn Screenings

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Department of Health, Bureau of Health
				  Services Financing shall provide reimbursement to the Office of Public Health
				  (OPH) through the Medical Assistance Program for newborn screenings performed
				  by OPH on specimens taken from children in acute care hospital
				  settings.
B. Reimbursement
1. Effective for dates of service on or after
				  August 5, 2017, claims submitted by OPH to the Medicaid Program for the
				  provision of legislatively-mandated inpatient hospital newborn screenings shall
				  be reimbursed outside of the acute hospital per diem rate for the inpatient
				  stay
a. The hospital shall not include any
				  costs related to newborn screening services provided and billed by OPH in its
				  Medicaid cost report(s).