This text of Louisiana § 46:977.9 (Healthcare benefits; cost sharing requirements) is published on Counsel Stack Legal Research, covering Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
§977.9. Healthcare benefits; cost sharing requirements
A.Subject to the General Appropriation Act of the legislature, the department shall
purchase or provide healthcare benefits for eligible children which are equivalent to the
benefits provided for children under the coverage requirements for the federal Children's
Health Insurance Program, Title XXI of the Social Security Act.
B.Subject to the General Appropriation Act of the legislature, as an alternative to
the health benefits outlined in Subsection A of this Section, and when cost-effective to the
state, the department may provide premium assistance to families toward the cost of privately
sponsored health insurance, including employer-sponsored and individually purchased health
insurance.
C.The content and availability of benefit
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§977.9. Healthcare benefits; cost sharing requirements
A. Subject to the General Appropriation Act of the legislature, the department shall
purchase or provide healthcare benefits for eligible children which are equivalent to the
benefits provided for children under the coverage requirements for the federal Children's
Health Insurance Program, Title XXI of the Social Security Act.
B. Subject to the General Appropriation Act of the legislature, as an alternative to
the health benefits outlined in Subsection A of this Section, and when cost-effective to the
state, the department may provide premium assistance to families toward the cost of privately
sponsored health insurance, including employer-sponsored and individually purchased health
insurance.
C. The content and availability of benefits described in Subsection B of this Section
and the terms of eligibility for those benefits shall be at the discretion of the department. The
department shall determine the efficacy and cost-effectiveness as a means of promoting
retention of private or employer-sponsored health insurance. If the department provides
benefits described in Subsection B of this Section, the department shall not be required to
provide services under any provision of Title XIX or Title XXI of the Social Security Act.
D. The responsible party for a child enrolled in the program shall be subject to the
following cost-sharing requirements for subsidized insurance:
(1) The department shall by rule establish requirements concerning monthly
premiums, co-payments, and coinsurance for healthcare services. This cost sharing shall be
on a sliding scale based on family income up to three hundred percent of the applicable
federal poverty guideline as published in the Federal Register by the United States
Department of Health and Human Services. The department shall work in consultation with
the Louisiana staff of the Children's Defense Fund, Agenda for Children, Louisiana Maternal
and Child Health Coalition, Covering Kids and Families, Louisiana Partnership for Children
and Families, Families Helping Families of Louisiana, Louisiana Chapter of the National
Association of Social Workers, Louisiana Chapter of the American Academy of Pediatrics,
Louisiana Chapter of the March of Dimes, and Louisiana Primary Care Association in the
rulemaking process regarding the sliding scale, which is based on family income.
Notwithstanding this Paragraph, there shall be no co-payment required for well-baby or
well-child health care, including but not limited to age-appropriate immunization as required
under state and federal law.
(2) The responsible party for a child enrolled in a privately sponsored health
insurance plan under this Part shall be subject to the cost-sharing provisions stated in the
privately sponsored health insurance plan.