§ 46:977.24 — Eligibility factors; benefits; premium payment program participation

Louisiana § 46:977.24

• Jurisdiction: Louisiana
• Title 46: Public Welfare and Assistance

Text

§977.24. Eligibility factors; benefits; premium payment program participation
A. In order to be eligible for the TEFRA option, a child shall meet all of the
following eligibility criteria:
(1) He is a Louisiana resident and United States citizen.
(2) He is under the age of nineteen.
(3) He has a disability that is recognized under the definition of disability utilized in
the Supplemental Security Income program of the Social Security Administration, regardless
of whether he is eligible to receive benefits under that program.
(4) He is ineligible for Medicaid coverage when the income of his parents is
considered.
(5) Excluding the assets of his parents, he does not have total assets exceeding two
thousand dollars in value.
(6)(a) Due to his disability, he requires a level of care provided in a hospital, skilled
nursing facility, or intermediate care facility; however, care provided outside of such an
institution may be appropriate.
(b) A child may meet a level of care if, within the last twelve months, he presents for
emergency care in a hospital more frequently than once per month and the use of the hospital
is medically necessary to stabilize sickle cell anemia.
(7) The cost of his care provided at his home is less than the cost of institutional care.
B. The TEFRA option shall provide to eligible children coverage for all Medicaid
state plan services.
C. To the maximum extent practicable, as determined by the secretary, the
department shall include TEFRA option beneficiaries in its health insurance premium
payment program as a means of maximizing private health insurance coverage of Medicaid
enrollees.

Legislative History

Acts 2019, No. 421, §1; Acts 2025, No. 294, §1.