Act 421 Children's Medicaid Option (421-CMO)

Act 421 of the 2019 Regular Legislative Session provides for a program through which children with disabilities can access Medicaid-funded services regardless of their parents' income. This program furnishes Medicaid benefits to children with disabilities who are otherwise ineligible for such benefits because the income of their household exceeds state-established limits for Medicaid eligibility.

Act 421 is modeled after The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982, which is a United States federal law that can help families with children younger than 19 years’ old who have a disability receive care in their homes rather than an institution.

In Louisiana, this Medicaid eligibility program is called the Act 421 Children’s Medicaid Option. This optional Medicaid eligibility proposal is subject to approval by the Centers for Medicare and Medicaid Services (CMS).


In order to be eligible for the Act 421 Children’s Medicaid Option, a child must meet all of the following eligibility criteria:

  • Louisiana resident and United States citizen.
  • Under the age of nineteen.
  • Has a disability that is recognized under the definition of disability utilized in the Supplemental Security Income program of the Social Security Administration, regardless of whether the child is eligible to receive benefits under that
  • Ineligible for Medicaid coverage when the income of the child’s parents is considered.
  • Excluding the assets of parents, the child does not have total assets exceeding two thousand dollars in value.
  • Due to disability, the child requires a level of care provided in a hospital, skilled nursing facility, or intermediate care facility; however, care provided outside of such an institution may be appropriate.
  • The cost of care provided at home is less than the cost of institutional care.

Frequently Asked Questions

Act 421 – Children’s Medicaid Option Summary

Act 421 - Children's Medicaid Option

Draft Act 421 Children’s Medicaid Option Proposal

Act 421 – Children’s Medicaid Option Demonstration Application


Public Comments

The public comment period closed on August 10. Comments received will be included in the proposal submitted to CMS.


Get Involved

The Louisiana Department of Health wants input from parents and advocates as we continue to work to develop Act 421 Children’s Medicaid Option. Email if you’re interested in joining a stakeholder work group.