La. Admin. Code tit. 50 § III-20503

Current through Register Vol. 50, No. 11, November 20, 2024

Section III-20503 - Eligibility Criteria

A. This LaCHIP stand-alone program provides health care coverage to uninsured children who meet the following criteria:

1. are under the age of 19;

2. have family income from 200 percent up to 250 percent of the federal poverty level

3. do not have creditable health insurance coverage; and

4. are not eligible for any other Medicaid program.

B. For the purpose of determining eligibility for phase five of LaCHIP, children are considered to be uninsured if they do not have creditable health insurance at the time of application. Children shall not be considered uninsured if their creditable coverage is dropped within the 12 calendar months prior to application, unless the reason for dropping the coverage is considered to be involuntary loss of coverage. Loss of coverage for one of the following reasons shall be considered involuntary loss of coverage:

1. loss of coverage resulting from divorce or death of a parent;

2. the child reaches his maximum lifetime coverage amount;

3. expiration of coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 continuation provision within the meaning given in 42 U.S.C. 300gg-91;

4. involuntary termination of health benefits due to;

a. a long-term disability or medical condition;

b. termination of employment, including lay-off or business closure; or

c. reduction in the number of hours of employment;

5. changing to a new employer who does not provide an option for dependent coverage; or

6. the family terminated health insurance coverage for the child because private insurance is not cost effective (the cost to the child's family for the coverage exceeded 10 percent of the family's income).

La. Admin. Code tit. 50, § III-20503

Repromulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 34:660 (April 2008).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XXI of the Social Security Act.