"vU10nl IICrA-PII-U"'4 AUGUST Utl

(SPIll IUPPLEMEIIT 2 '10 A'ITACIDCEIIT 2. I-A .ave 1 CIICB 110. I onl-

ITATE PLAII UJlDER TITLE lUI or 'J'HE IOCIAL IlCUIlln acr . Itatel LOUISIANA

USOUIICE LEVELS

A. CATEGORICALLY llEEDY GItOUPS WITH IIICOMES ULA'l'ED '10 nDEIIAL POVERTY LEVEL

1. 'r'qnln& 'p8.n

a. "Indltory Crpup'

L:7 Sa.e a. lSI re.ourca. level ••

~I Le •• re.tr1ct1ve than 151 re.ource level. and 1. a. follow.,

r •• ily s'I'

b. Optipn'! Grpyp.

RllpYtS. Lty.l

NONE· *In accordance with Attachment 2.6-A. Item C.5.e . of the Plan.

L-I Same a. lSI re.ource. level ••

L-I Le •• re.tr1ct1ve than 151 re.ource level. and 1. a. follow.,

r.mily I'" "'oure, Lty.l

W .. o. ~~'~U~------~~~R~O~2~1~~Z--------------O-C-T-O-l-199--1--:~!~edn trpproval Data ______ Effactiva Date

HcrA IDI nUE

JJ

SiATEl"i'l- .. ~ ,,0', TE r~~'D DEC (15 1991 ;. ~~.~ l A~'tl'C A'ti'cf fi i'IIl - A :~/.i;,; ~f+_

He,,,, ::'9 ~1r'2.3

Superseded by 13-49: see Section 2.8 Modified Adjusted Gross Income (MAGI) Effective date January 1, 2014

... 1.10ft. MCrA-PM-'l-. CUD) IVPPLEMEIIT 2 'l'O A'I'1'ACIOcnT 2.'-A ADQJSt 1"1 '.9. 2 '

OlD 110.. OUI~ "

nATE ,LAII URllEl\ TITLE lUX or 'I'll! SOCIAl. llCUUn ~

It.t •• LOUISIANA

2. Infant.

a. landatpry GrRUP pr Infant.

L:i Saa ••• ~ •• ou~c. 1 ••• 1. 1ft the St.t.' •• pp~o.ed ArDC plan .

~I Le •• ~ •• t~1ct1y. than the ArDC 1 ••• 1 •• nd a~ ••• followa :

r •• !ly .". "'pyre. Lty.l

NONE·

,.. Mo . !!I-Pi App~o.al Date APR 02 1992

* In accordance with Attachment 2.6-A, Item C. 5,f, of the Plan

ocT h i§§i Iff.cUve Dat. ______ _

HerA ID. "lSI

/)

STATE /'J I t"Ze ... ..I~ D" TE P,';':'D DEC 0519§'1 I "'-' ",'P" " 1{PR 02 1991 A to· , I... I \ L

I :~:~ ~~ ~ - ~f. ~., .

Superseded by 13-49: see Section 2.8 Modified Adjusted Gross Income (MAGI) Effective date January 1, 2014

"vl.lon: HCrA-PM-'l-4 AUGUST un caPP) IUPPLDCPT 2 !'O A'M'ACIOIEIft 2.I-A

.ave 1 OMS .0. I OUI- . .

ITATE ,1.AN UNDER TITloE XIX or THE SOCIAL llCUatft. AC'l'

Itete: LOUISIANA

b. Optional Group pt lof,o&.

L-I , ... e. re.ource level. ln the Itete'e epprowed AFDC plen.

L-I Le •• re.tr1ct1ve then the ArDC level. and are a. followa:

,amily 11J' I •• oure. Lty.l

,.. tlo. 91-&1 Approval Date APR 02 199Z OCT 01 1§91 Iffective Date ______ _

IlerA ID: 'tin

A DA '0 DEC 0 5 1991

CATE APFY·D __ ~IL..I~'"

C.' .• : ~F;: _--,,.;..,;.....,,,.:...::~=---

Her." 179

Superseded by 13-49: see Section 2.8 Modified Adjusted Gross Income (MAGI) Effective date January 1, 2014

Ravi8ion. HcrA-PM-92-1 FEBRUARY 1992

(HI) SUPPLEMENT 2 TO ATTACKHZNT 2.6-A Pa9a 4

STATE PLAN UNDER TITLZ XIX 0' THE SOCIAL SZCURITY ACT

Statal IQttISTQNQ

3. Childran

a.

Same a. ra.ourca laval. in tha Itata'. approvad APDC plan.

X La •• ra.trietiva than tha ArDC laval. and ara a. tollowa.

ramily Sin

-L

Ra.ourea Laval

tJ~ .:~::::::.::t-e:..· ___ ·-=:In accordance with

:l,t.. ~E

Attachment 2.6-A, Item C. ------ 5.f. of the Plan •

. ,..-APR \I 6 1992

A 'I :l ... 7r of" ----,4 .... ;l,-.-O-1-:----

He:., Ii'; -==-~=-=-=::-: .. = ____ ...I .- --.- ...

roval Data MAY 1 4 1992 R 01 1992 affaeti"a Data ______ _

Superseded by 13-49: see Section 2.8 Modified Adjusted Gross Income (MAGI) Effective date January 1, 2014

• .. .,hion. BCrA-PH-t2-2

IWICII 1"2 (III) .UPPLIMKKT 2 to ATTACHMEIT 2.6-A

'ave I

b.

.TATI PLNI UNDIII TITLI XIX OF TBI IOCIAl. .ac:uaIft aer

.tat •• LOUISIANA

.Iame a. r •• ource 1 • .,.1. 1n the .tat.'. approved APDC plan.

X Le •• r •• trict1.,. than the ArDC 1 • .,.1. and ar. a. followa.

FamUy Ih.

-L. ---L-_3_

.-L.

....L ---L.

---2-

.-L.

--2-..lL

".oure. LeY.l NONE

A

-----==~~==,--

Superseded by 13-49: see Section 2.8 Modified Adjusted Gross Income (MAGI) Effective date January 1, 2014

... 1Uonl IICrA-PM-U- 4 AUGUST 1tt1

carD) IUPPLEKEMT 2 ~ ATTA~ 2.'-A 'ava , OICI .0. I onl-

--

ITATE 'LAII UJII)EII TITLE XIX or THE IOCIAt. II<:UaZ'n' ~

Itatal LOUISIANA

t. laid and Dl •• bl.d Ind1y1dy,l.

~ S ... a. lSI r •• ourc. 1 ••• 1a.

L-I Mor. r •• tr1ct1v. than SSI 1.v.l. and ar ••• followel

",ily Ill' '"our;, Lty.!

•

L-I Sam. a ... d1cally ne.dy r •• ourc. 1.v.l. (.pp11cab1. only 1f Itat. ha. a aed1cally needy pro;raa)

Approval o.u APR 02 1992 Eff.ctiv. Dat. OCT 01 19i'1

HcrA ID: "ISE

/')

STAT~ iii :..~~ ~~

:l .... TE P.E,c-o '0 5 ~1 OAiE A~P\"C £.1_1 O .... TE Er ,:

HCFA f7', ~/-~3 ---' A

Revision: LA December 2001

SUPPLEMENT 2 TO ATTACHMENT 2.6-A Page 7

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: LOUISIANA

RESOURCE LEVELS (Continued)

B. MEDICALLY NEEDY

Applicable to Aged, Blind , and Disabled -

D Except those specified below under the provisions of section 1902 (f) of the Act.

Family Size

1 ~ .3. 1 ,? Q 1 ~ 2 10

For each additional person

Resource Level

$2000 $3000 $3025 $3050 $3075 $3100 $3125 $3150 $3175 $3200 $25.00

*** Child related Medically Needy Programs-No resource limit. -See Supplement 8b to Attachment 2.6-A, Page 1

STATE Lou.t i>~0-V) 0-

DATE REC'D \ "2-"<-:&;-P-L_ DATE APP\I'D Q"L-2L..-QL.. A DATE EFF 1! -2- I -Q I

HCFA 179 LA -Ol- 110

TN No . Q 1-1 \0 Supersedes

Approval Date 0').-2"'2. -0 '2-

TN No. ql-I ("

Effective Date {( - 2- 1- 0 1