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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued October 24, 2025 Page 1 of H-2300 Replacing April 21, 2025 Revised/added text indicated by underscore Deleted text indicated by “*” H-2300 FAMILY OPPORTUNITY ACT MEDICAID BUY- IN PROGRAM

H-2310 GENERAL INFORMATION

On October 1, 2007, the Family Opportunity Act Buy-In Program (FOA) was implemented to cover children with disabilities up to age 13, and family gross income at or below 300 percent of the Federal Poverty Income Guidelines (FPIG).

Effective October 1, 2008, the program expanded to include children with disabilities up to age 19. When applicable deductions are applied this makes the family gross income limit effectively at or below 300 percent of the FPIG.

Families wishing to enroll their child(ren) with disabilities in the program are required to take employer-offered insurance when it is available, and when the following conditions apply: • The coverage is under a group health plan; and • The employer contributes at least 50 percent of the total annual premium.

Applicants/beneficiaries are eligible for the full range of Medicaid covered services.

In FOA, a person is only required to obtain/maintain creditable coverage. For instance, if a person has coverage and it is no longer creditable, the coverage may be dropped.

H-2320 ELIGIBILITY DETERMINATION PROCESS

Determine eligibility by applying the following criteria. The elements have been listed in the most logical order, but work on all steps simultaneously.

Explore eligibility for programs that offer full Medicaid benefits without a premium before considering FOA.

Note: Individuals with disabilities no longer have income deemed from their parents upon reaching age 18. Eligibility in other Medicaid programs, such as Provisional Medicaid, should be explored to ensure certification in the most beneficial program and that premiums are not being charged to these individuals unnecessarily.