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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued March 14, 2023 Replacing August 29, 2022 Page 1 of H-3800 Revised/added text indicated by underscore Deleted text indicated by “” H-3800 ACT 421 CHILDREN’S MEDICAID OPTION (TEFRA)

H-3810 GENERAL INFORMATION

The Act 421 Children’s Medicaid Option (Act 421-CMO), implemented January 1, 2022, will cover individuals under age 19 who qualify with a disability who are living in the community and who meet the level of care provided in a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities.

Only the income and resources of the Act 421-CMO child are counted in the eligibility determination process. This allows children with complex medical needs to qualify based on their own income and resources to receive medical services in a less-costly home setting, instead of an institution when such care can be provided safely at home.

Note: Parental income and resources can be used to explore eligibility for Medicaid and CHIP programs that offer full benefits before ACT 421 –CMO with the exception of LAP and FOA. Consider eligibility for ACT 421- CMO before LAP and FOA **.

H-3810.1 Coverage

Act 421-CMO beneficiaries receive the full range of Medicaid covered services.

H-3810.2 Medical Certification

BHSF Form 142 – Notice of Medical Certification indicates if the applicant/beneficiary meets the level of care requirements for hospital, skilled nursing facility, or intermediate care facility for individuals with intellectual disabilities (ICF/IID).

The Office for Citizens with Developmental Disabilities (OCDD) Local Governing Entity (LGE) issues the BHSF Form 142.

The BHSF Form 142 documents the following: • Approval or disapproval of the level of care; and