Best Medicaid Pending Guide for Louisiana Families Facing a Nursing Home Deadline
The best resource for a Louisiana family in Medicaid Pending status is one that answers a single urgent question correctly: what do you actually owe the nursing home right now, and what can you legally refuse to pay. The short answer is that you owe the estimated "Patient Liability" — your parent's income minus a small set of deductions — not the facility's full private rate, and the nursing home cannot legally evict a resident whose application is actively pending. Families who pay the full $7,200/month private rate out of fear, or who sign a personal financial guarantee under pressure from a facility's billing office, lose money they didn't need to lose during a period that's designed to be temporary.
The Trigger: Medicare Runs Out, and the Clock Starts
This situation almost always starts the same way. A parent is hospitalized — a stroke, a fall, a hospitalization tied to advancing dementia — and transfers to a skilled nursing facility for rehabilitation under Medicare's Skilled Nursing Facility benefit. That benefit covers up to 100 days per benefit period, with a substantial daily co-insurance fee starting on day 21. Somewhere around day 80 to 100, a discharge planner or social worker tells the family that Medicare coverage is ending and the facility's private rate — averaging $7,200/month in Louisiana — is about to become the family's responsibility.
That's the moment families realize their parent's savings could be gone in a matter of months, and it's also the moment "Medicaid Pending" enters the conversation.
What "Medicaid Pending" Actually Means
Medicaid Pending is the status your parent holds between the day a completed application is submitted and the day LDH issues a decision — typically a 45- to 90-day window. During this period, your parent is not yet approved, but they also are not required to pay the facility's full private rate. Federal anti-eviction rules prohibit a nursing home from discharging a resident solely because their Medicaid application is pending.
Instead, the family calculates and pays the estimated monthly "Patient Liability" — the share of cost the applicant would owe once approved. This is calculated as gross monthly income minus:
- The $45 Personal Needs Allowance
- Health insurance premiums
- Any applicable spousal income allowance under spousal impoverishment rules
Once LDH approves the application, the state retroactively covers the pending period at the Medicaid facility rate, back-paying the difference between what the family paid in Patient Liability and the full rate.
What to Do — and Not Do — While Pending
Do: Calculate the estimated Patient Liability using gross income minus the allowed deductions, and pay that amount to the facility's business office each month. Keep records of every payment.
Do: Ask for the facility's billing contact in writing and document all communication.
Don't: Pay the full $7,200/month private rate out of fear of eviction — this is not what you owe during the pending period, and it can take months to recover overpayments.
Don't: Sign a personal financial guarantee. Nursing homes sometimes pressure family members — particularly whoever signed the admission paperwork — into personally guaranteeing payment. This is a separate legal obligation from your parent's Medicaid liability, and once signed, it can make you personally responsible for costs regardless of the Medicaid outcome.
Don't: Assume silence from the facility means the account is fine. Nursing home billing offices sometimes escalate to collections during the pending period out of process, not because your family owes the full rate — a documented Patient Liability payment history is your defense.
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Clinical Eligibility Runs on a Separate Track
Financial eligibility and clinical eligibility are reviewed separately, and both have to clear before Medicaid approves the application. The clinical side runs through the Level of Care Eligibility Tool (LOCET), triggered by a physician completing Form 90-L — the Request for Medical Eligibility Determination. This confirms your parent meets the Nursing Facility Level of Care standard. Gainwell Technologies, LDH's fiscal intermediary, reviews this alongside the financial application during the 45-day pending window.
Families sometimes assume that once the financial paperwork (BHSF Form 1-L, bank statements, the AVS consent form) is submitted, the clock is running toward approval. If Form 90-L hasn't been completed and submitted by the treating physician, the clinical side stalls regardless of how clean the financial application is — and that delay extends the pending period, and the Patient Liability payments, right along with it. Confirming Form 90-L has actually been filed is one of the first things to check if a pending application seems to be taking longer than the typical 45-to-90-day window.
Comparison Table: Sources of Help During the Pending Period
| Resource | Cost | Explains Patient Liability Math | Handles Billing Disputes | Speed |
|---|---|---|---|---|
| Louisiana Medicaid planning guide | Yes — worksheet included | Provides letter template | Immediate | |
| LDH / LaMEDS helpline | Free | General rules only | No | Long hold times |
| Facility social worker | Free | Sometimes, informally | Limited — represents the facility, not you | Immediate but conflicted |
| Elder law attorney | $300–$500/hr | Yes, in detail | Yes, can intervene directly | 2–4 weeks to schedule |
Who This Is For
- Families whose parent's Medicare Skilled Nursing Facility days are running out, with no Medicaid decision yet
- Adult children being pressured by a nursing home's billing office to pay the full private rate or sign a guarantee
- Anyone unsure how to calculate what they actually owe during the pending window
- Families who want a defensive, documented paper trail in case the application is delayed or a dispute arises
Who This Is NOT For
- Families whose Medicaid application hasn't been filed yet — resolve the eligibility and asset questions first, since Pending status only starts once a completed application is submitted
- Situations already in active collections or legal dispute with a facility — that needs an attorney, not a planning guide
- Anyone whose parent's income situation is complex enough that the Patient Liability calculation genuinely requires professional review (multiple income sources, contested spousal allowance amounts)
Tradeoffs
Handling the pending period yourself, with the right worksheet, is nearly always cheaper and faster than waiting for an attorney consultation — which can take 2 to 4 weeks to schedule, time your family may not have when a facility is pressuring for payment today. The tradeoff is that a guide can't intervene directly with a facility's billing office or represent you if a dispute escalates to a legal threat.
The Patient Liability calculation itself is usually straightforward — gross income minus a short, defined list of deductions — but if your parent has multiple income sources, a community spouse whose allowance amount is contested, or health insurance premiums that aren't clearly documented, get the number verified before committing to a monthly payment amount. An error here either overpays the facility or underpays and creates a documented shortfall.
Frequently Asked Questions
Can a nursing home evict my parent while their Medicaid application is pending?
No. Federal anti-eviction protections prohibit discharging a resident solely because their Medicaid application is pending, as long as the family is making documented, good-faith Patient Liability payments.
How is Patient Liability calculated during the pending period?
Start with gross monthly income. Subtract the $45 Personal Needs Allowance, any health insurance premiums, and — if there's a community spouse — the Monthly Maintenance Needs Allowance amount diverted to them. What remains is the estimated Patient Liability owed to the facility each month.
What happens to the money I paid once Medicaid is approved?
Once LDH approves the application, the state reimburses the facility retroactively at the Medicaid rate for the entire pending period, back to the application date. Any Patient Liability payments the family made during that window are credited toward the total owed — you don't pay both the Patient Liability and the full retroactive Medicaid-covered amount.
Should I sign whatever the nursing home's billing office puts in front of me?
Not without reading it carefully. Some facilities present forms that function as personal financial guarantees, making a family member personally liable for costs separate from the parent's Medicaid outcome. Signing the admission agreement as the resident's representative is different from personally guaranteeing payment — know which one you're being asked to sign.
What if the Medicaid Pending decision takes longer than 90 days?
Processing delays happen, often due to missing documentation or a backlog. Continue paying the calculated Patient Liability and keep requesting a status update through LaMEDS or the facility's designated Medicaid liaison. A longer pending period doesn't change what you owe — it just means retroactive reimbursement, once approved, covers a longer window.
Where can I get the exact Patient Liability worksheet and a letter template for the facility?
The Louisiana Medicaid Long-Term Care & Asset Protection Guide includes a "Medicaid Pending Survival Protocol" chapter with a Patient Liability Letter Template — a formal notice to send the facility's billing manager declaring pending status, enclosing the calculated payment, and citing the anti-eviction rules that protect your family during this window.
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