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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued May 1, 2023

Page 1 of H-3050 Replacing July 7, 2016 Revised/added text indicated by underscore

Deleted text indicated by “**” H-3050 CHILDREN UNDER AGE 19 - LaCHIP PHASE IV (SCHIP) H-3051 GENERAL INFORMATION

Effective May 1, 2007, the Louisiana Department of Health and Hospitals (DHH) implemented an expansion of the State Children’s Health Insurance Program (SCHIP) to provide prenatal care services, from conception to birth, for low income uninsured mothers who were not otherwise eligible for Medicaid. This Louisiana Children’s Health Insurance Program (LaCHIP), called LaCHIP Phase IV, also covers non-citizen women who are not qualified for other Medicaid programs due to citizenship status only.

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The Patient Protection and Affordable Care Act of 2010, referred to as the Affordable Care Act (ACA), combines all mandatory and optional eligibility groups for individuals under age 19 into one coverage group. LaCHIP Phase IV is considered under the Children Under Age 19 Group as the program benefits the unborn child from conception to birth. Eligibility for LaCHIP Phase IV is determined by using Modified Adjusted Gross Income (MAGI) methodology.

MAGI based income for LaCHIP Phase IV beneficiaries must not exceed 214 percent of the Federal Poverty Level (209 percent FPL, plus a 5 percent disregard).

H-3052 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.

H-3052.1 Determine Assistance/Benefit Unit

The assistance/benefit unit consists of the pregnant woman.

H-3052.2 Establish Categorical Requirement

A LaCHIP Phase IV pregnant woman must be pregnant for each month of eligibility.

H-3052.3 Establish Non-Financial Eligibility

Verify eligibility for each member of the assistance/benefit unit with regard