LAC 50:XXXIII.7103. Recipient Qualifications

A. The targeted population for the 1915(b)(3) services shall be Medicaid recipients who: 1. are at least 21 years of age; 2. have a qualifying mental health diagnosis; 3. meet medical necessity in accordance with LAC 50:I.1101; and 4. have transitioned from a nursing facility or been diverted from nursing facility level of care. B. Recipients of personal care services (PCS) must meet the following additional recipient eligibility criteria: 1. recipients must be medically stable; 2. recipients shall not be enrolled in a Medicaid-funded program which offers a personal care service or related benefit; and 3. recipients’ care needs do not exceed that which can be provided under the scope and/or service limitations of PCS. C. An adult with a diagnosis of a substance use disorder or intellectual and developmental disability without an additional co-occurring qualifying mental health diagnosis shall not meet the criteria for mental health services.