20507 Cost Sharing

A. Phase five of LaCHIP is a cost-sharing program with premiums limited to no more than 5 percent of the family’s annual income.

B. The following cost-sharing criteria shall apply.

1. Premiums. When family income is between 201 percent and 250 percent of the federal poverty level, families shall be responsible for paying a $50 per month premium.

a. Benefits begin after the first premium is received. Premiums are due by the tenth of each month.

b. Coverage may be terminated at the end of the twelve-month continuous eligibility period if:

i. premiums remain unpaid; and

ii. at least 60 days have passed since the premium due date.

c. Notice of Nonpayment and Grace Period. Before termination, a written notice will be sent to the family that includes:

i. a 30-day grace period to pay the unpaid premiums;

ii. a warning that failure to pay within the 30-day grace period will result in termination of coverage; and

iii. information on the family’s right to appeal the proposed termination.

d. Termination Notice. If the family does not pay the premiums within the 30-day grace period, a termination notice will be issued that complies with the requirements in 42 CFR §457.340(e).

e. Payment after Grace Period. If the family pays the premiums after the 30-day grace period but before the end of the eligibility period, coverage will not terminate for failure to pay premiums.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XXI of the Social Security Act.

HISTORICAL NOTE: Repromulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 34:661 (April 2008), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1292 (July 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 52:1189 (July 2026).