LAC 50:XXIX.315. Recipient Profile Review

A. Recipients profiles are to be reviewed periodically as described in the Lock-In Procedure Manual (for determination of continuance or discontinuance of lock-in). The department’s medical designee(s) examine(s) a recipient’s profile for a continued pattern of misuse or overuse of program benefits. Periods of ineligibility for Medicaid will not affect the lock-in status of the individual. A review at the end of the first four months of ineligibility of lock-in closure will be made to determine if lock-in should be continued. Based upon a recommendation of the department’s medical designee, a decision may be made to restore unrestricted benefits and appropriate notification will be provided to the recipient.