Act 421 Children's Medicaid Option (421-CMO) | Louisiana Department of Health Full Coverage Physical and Behavioral Health Benefits Act 421 Children's Medicaid Option (421-CMO) Act 421 Children's Medicaid Option (421-CMO) Act 421 of the 2019 Regular Legislative Session authorized the Louisiana Department of Health to create a TEFRA program. TEFRA (Tax Equity and Fiscal Responsibility Act) is a federal law that allows certain children with disabilities to qualify for Medicaid based on their own needs, not their parents' income.  This program helps some children with disabilities get Medicaid, even if their parents earn too much money to normally qualify. Contact E-Mail Us or Call 1 (800) 230-0690 Who Can Qualify To be eligible for Act 421-CMO, a child must meet all of the following requirements. The child must: Live in Louisiana; Be a U.S. Citizen or an eligible non-citizen; Be age 18, or younger; Have a disability, as defined by the Social Security Administration; Have limited savings or resources, within SSI limits; Have an income at or below the special income limit for long-term care, whichis three (3) times the Federal Benefit Rate (FBR) (parent's income is excluded); Need a high level of care, similar to care provided in a hospital, nursing facility, or ICF/IID; and Be able to safely receive care at home. How to Enroll in Act 421-CMO There are four main steps to enroll. Step 1 Completing a Medicaid Application Not sure if you qualify? Apply to find out. IMPORTANT If you do not choose a health plan, one will be chosen for you. Visit Choose a Plan for more information about selecting a plan. When applying online, make sure you: Check the box showing the child has a disability on the Additional Personal Details screen: Select the child and choose “Disabled” from the list If you apply using a paper application, answer “yes” to the disability question (as shown in question 12 below) so your application is reviewed for Act 421-CMO Step 2 Level of Care Review Your local Human Services District will review your child’s needs to see if they meet the required level of care. You will receive a packet with forms to complete and return. It is very important to Fill out all forms completely Include any requested medical records Send everything back on time If the forms are missing or incomplete, your application may be denied. The packet may include: A cover letter with instructions A form allowing Medicaid to request medical information, if needed Medical review forms completed by your child's doctor You can submit the completed packet by: Fax to: 1(225) 389-8019 Email to [email protected] Mail: Medicaid Application Office 6069 I-49 Service Road Ste B Opelousas, LA 70570 Online (Instructions here If your child meets the level of care requirement, you move to Step 3. Step 3 Disability Review Your child must meet the Social Security Administration’s definition of disability. If Social Security has not already made a disability decision, Medicaid will request one. You may be asked to provide more medical information. If your child is approved, you move to Step 4. Step 4 Medicaid Enrollment If your child meets the medical and financial requirements, they will receive Medicaid through a Healthy Louisiana health plan. When applying, you may choose a health and dental plan. If you do not choose one, a plan will be selected automatically. Louisiana Health Insurance Premium Program (LaHIPP) If your child is enrolled in Act 421-CMO, they may also qualify for LaHIPP. LaHIPP may help pay for: Your job-based insurance, or An individual health insurance plan Important : If your child is approved for LaHIPP: Physical health services will be covered by fee-for-service (also known as traditional or legacy) Medicaid Behavioral health and transportation services will stay with the Medicaid health plan Before enrolling in LaHIPP, check to make sure your child’s doctor accepts this type of Medicaid coverage. You can use the Find a Provider tool to check. For more details, please review the Act 421 Frequently Asked Questions Archived Act 421-CMO Materials Act 421 - Stakeholder Work Group - Post COVID Timeline Act 421 Children’s Medicaid Option Summary - Presentation Act 421 Children’s Medicaid Option Summary - Video Recording 7/22/2020 Act 421 Implementation - Stakeholder Work Group 6/22/2020 More Resources Resources Information for Families Applying for Act 421-CMO Level of Care Assessment Process ACT 421-CMO/TEFRA Application Process Frequently Asked Questions Information on the Annual Renewal Process ACT 421-CMO/TEFRA Renewal Process Surgeon General Evelyn Griffin, MD Secretary Bruce D. Greenstein Cicero Government