• Qualified Medicare Beneficiary (QMB): The income limit is $1,235 a month if single and $1,663 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if a beneficiary owes them – it also pays their Part A premiums.
• Specified Low Income Medicare Beneficiary (SLMB):  The income limit is from QMB levels up to $1,478 a month if single and $1,992 a month if married. SLMB pays for Part B premiums.
• Qualified Individuals (QI): The income limit is from SLMB levels up to $1,660 a month if single and $2,239 a month if married. QI pays for Part B premiums.

MSP asset limit: MSP asset limits: There is no MSP asset limit in Louisiana.

Medicare covers many services – including hospitalization, physician services, and prescription drugs – but can leave enrollees with significant out-of-pocket costs (i.e., deductibles, co-pays, and coinsurance). Original Medicare also does not cover important services like vision and dental benefits, although Medicare Advantage plans sometimes do offer this coverage.

Medicare enrollees with low incomes and assets can receive coverage for Medicare cost sharing and additional services like vision and dental care if they’re enrolled in Medicaid benefits for the aged, blind and disabled (ABD).

In Louisiana, Medicaid ABD covers dental care for adults, including diagnostic care (e.g., exams and x-rays), and complete or partial dentures.

Medicaid ABD does not cover routine eye exams in Louisiana. But Medicaid would provide secondary payment for eye care services Medicare does cover, such as cataract surgery.

Income eligibility: The income limit is $914 a month if single and $1,371 a month if married.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.

The income and asset limits for QMB, SLMB and QI are based on an applicant’s marital status. But eligibility rules for QDWI, Medicaid ABD and long-term care Medicaid instead vary based on the number of household members.

Applicants whose incomes are too high to qualify for Medicaid ABD can take advantage of the Medicaid spend-down in Louisiana. This program allows applicants to use incurred medical expenses to lower their countable income to become eligible for Medicaid.

When an applicant is approved for the spend-down, Medicaid calculates the portion of their monthly income above the program’s income limit – which is known as “excess income.” Enrollees activate their spend-down benefits by showing they have medical bills equal to their excess income. An applicant’s excess income is reduced by any payments for health insurance premiums (such as Medicare Part B or Medigap).

In Louisiana, Medicaid spend-down benefits are approved in three-month increments, with additional coverage requiring new medical expenses to be submitted.

In Louisiana, the Medicaid spend-down covers Long Term Services and Supports (LTSS).

Income eligibility:

• In Urban Areas (defined as East Baton Rouge, Jefferson, Orleans and St. Bernard Parishes), the income limit is $100 a month if single and $192 a month if married.
• In all other areas of the state, the income limit is $92 a month if single and $167 a month if married.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.

With Americans living longer, more and more people need long-term care services. While Medicare generally does not cover long-term care, Medicaid may fill in the gaps. However, complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.

Applicants seeking long-term care coverage must undergo a needs assessment.

Medicaid nursing home coverage

Today, many seniors receive long-term care in their homes. But some seniors have medical or living situations that make nursing home care a better choice.

Income limits: The income limit is $2,742 a month if single and $5,484 a month if married (and both spouses are applying).

If only one spouse needs Medicaid, the income limit for single applicants is used and usually only the applying spouse’s income is counted.

Despite being allowed up to $2,742 a month in income (if single), nursing home enrollees can’t keep all of this money. Once they enter a nursing home, enrollees must pay all but a small portion of their income toward their care. They are allowed to keep a small personal needs allowance and money to pay for health insurance premiums (such as Medicare Part B and Medigap). In Louisiana, this allowance is $38.

Assets limits: The asset limit is $2,000 if single and $3,000 if married and both spouses are applying. If only one spouse needs Medicaid, the other spouse can keep up to $148,620.

These asset limits don’t count the value of many household effects, family heirlooms, certain prepaid burial arrangements, or a car.

Home and Community Based Services (HCBS) waivers

Medicaid also pays for community-based long-term care services for applicants who need support, but can demonstrate that they can still live safely at home or in an assisted living facility. Programs that cover this care are called Home and Community Based Services (HCBS) waivers.

Income limits: The income limit is $2,742 a month if single and $5,484 a month if married (and both spouses are applying).

If only one spouse needs Medicaid, the income limit for single applicants is used; generally only the applying spouse’s income is considered.

HCBS recipients in Louisiana can keep a personal needs allowance equal to the program’s income limit (of $2,742). This can be used to pay for health and living expenses.

Asset limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying). If only one spouse needs Medicaid, the other spouse can keep up to $148,620.

Spousal impoverishment protections in Louisiana

Spousal impoverishment rules allow the spouse of a Medicaid LTSS recipient to keep certain income and assets if they don’t receive Medicaid themselves.

In Louisiana in 2022, these spousal impoverishment rules allowed these “community spouses” to keep:

• An MMMNA that is between $2,288.75 and $3,435 per month.
• A Community Spouse Resource Allowance (CSRA) that is between $27,480 and $137,400.
• A housing allowance of up to $686.63 a month.

Permitted home equity in Louisiana

Federal law requires states to establish a limit for the home equity interest an applicant can have and still qualify for Medicaid nursing home or HCBS coverage.States set this home equity limit by choosing between a federal minimum of $688,000 and maximum of $1,033,000 in 2023.

Louisiana requires that enrollees for Medicaid LTSS have no more than $688,000 in home equity.

Penalties for transferring assets in Louisiana

The high cost of long-term care causes some individuals to consider giving away or transferring assets to others to become eligible for Medicaid LTSS benefits. To discourage asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value. States can choose to also have an asset transfer penalty for HCBS.

Louisiana has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 60-month lookback period. The penalty is calculated by dividing the amount of money transferred or given away by the monthly cost of care in a nursing home (and this amount is $5,000).

Medicaid does not pay for long-term care during this penalty period.

Estate recovery in Louisiana

State Medicaid agencies must try to recoup what they paid for long-term care related costs while a beneficiary was 55 or older. States can also choose to recover the costs for all other Medicaid benefits for those enrollees. This is called estate recovery.

As of 2015, Louisiana had chosen to only pursue estate recovery for enrollees who receive LTSS beginning at the age of 55.

The state will not pursue estate recovery if at least one of an enrollee’s heirs has an income below 300% of the federal poverty level.

When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with whom the state contracts to administer Medicaid benefits), the state will attempt to recover what it paid that MCO. This amount could be different from the actual cost of the Medicaid services received.

Senior Health Insurance Information Program (SHIIP)

Free-of-charge Medicare counseling is available by contacting the Senior Health Insurance Information Program (SHIIP) at 1-800-259-5301. This website has the locations for regional SHIIP “partners” in Louisiana.

SHIIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIIP counselors may also offer referrals to local agencies for services like home care and long-term care.

Elder Law Attorneys

The National Academy of Elder Law Attorneys (NAELA) has a search feature you can use to find an elder attorney who can help planning for long-term care needs.

Louisiana Aging and Disability Resource Centers (ADRCs)

Medicare beneficiaries in Louisiana can access counseling and assistance from an Aging and Disability Resource Center (ADRC). These organizations provide information about benefits and programs, and can help with planning for long-term care. You can visit this website for a list of ADRC regional offices in Louisiana.

Louisiana’s Medicaid program is administered by the Louisiana Department of Health (LDH). You can visit this website for more information about applying for Medicaid ABD or an MSP in Louisiana. The phone number for Medicaid applicants is 888-342-6207.