Page 1

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued September 30, 2024

Page 1 of H-3020 Replacing August 11, 2023 Revised/added text indicated by underscore

Deleted text indicated by “**” H-3020 Children Under Age 19 Group-CHAMP

H-3021 GENERAL INFORMATION

As a result of the Sixth Omnibus Budget Reconciliation Act of 1986 (SOBRA), Louisiana implemented the Child Health and Maternity Program (CHAMP) in January 1989, to provide Medicaid benefits to pregnant women and children under age 19 who meet income and non-financial eligibility criteria.

The Patient Protection and Affordable Care Act of 2010, referred to as the Affordable Care Act (ACA), combined all mandatory and optional eligibility groups for individuals under age 19 into one coverage group. This group includes those children covered under CHAMP.

Eligibility for applicants/beneficiaries in the children’s group is determined by using Modified Adjusted Gross Income (MAGI) methodology.

ACA expanded mandatory coverage to all children under age 19 with household MAGI-based income at or below 147 percent of the Federal Poverty Level (142 percent FPL, plus 5 percent disregard). Such children are considered CHAMP children.

There is no resource eligibility requirement for CHAMP children.

Note: CHAMP children include those previously ineligible children, ages 6-18 years old, with other health insurance. CHAMP children in this age group, with income between 108 percent and 147 percent FPL, who do not have other health insurance, should be certified in LaCHIP Category/Type Case 03-07. The state is allowed to collect enhanced funding for this group.

H-3022 ELIGIBILITY DETERMINATION PROCESS

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

H-3022.1 Determine Assistance Unit

The assistance unit consists of the child(ren) under age 19 for whom assistance is requested.