The Centers for Medicare and Medicaid Services (CMS) has granted approval for Louisiana Medicaid to launch Act 421 Children’s Medicaid Option, or TEFRA, effective January 1, 2022. This program allows certain children under 19 years of age with disabilities to receive Medicaid coverage, regardless of parental income.
The TEFRA option disregards family income for children with disabilities who meet specific criteria, so they may qualify for Medicaid to cover the services they need to grow and thrive while living at home.
To qualify, children must have a disability that is recognized under the definition utilized in the Supplemental Security Income program of the Social Security Administration and must meet basic Medicaid and institutional level-of-care requirements. Additionally, their care must cost less at home than in an institution.
“In our work each day within the Louisiana Department of Health, our goal is to help individuals receive care in a safe setting of their choice. We are grateful for both of our legislators and to CMS for approval to offer an option allowing children to remain in their homes to receive care that will help them thrive,” said LDH Secretary Dr. Courtney N. Phillips.
“This is a great day for families with children with disabilities in Louisiana,” said Rep. Dodie Horton. “TEFRA will allow these children to avoid long stays in hospitals and get the care they need while living at home in the comfort of their family and friends.”
“We are excited about this new program and the significant impact it will have on our working families and children with disabilities to help make their lives easier while providing much-needed services,” said Rep. Dustin Miller. “Thanks to all of our stakeholders and other community partners for working with us to help move this forward.”
“Good health insurance often only covers a small portion of what children with disabilities need. This puts working families in a terrible predicament. Families can’t quit their jobs to get help. And they can’t help their kids without jobs," said Ashley McReynolds, Parent and Program Director at The ARC of Louisiana. "TEFRA will be such a huge help in assisting families with the extraordinary cost of raising a child with a disability.”
Applications for the TEFRA program may be submitted beginning January 1, 2022. Applicants must complete four steps which include 1) Medicaid Application, 2) Level of Care Assessment at your Local Governing Entity, 3) Disability Determination, and 4) Enrollment/Service Coverage through a Healthy Louisiana plan.
Consideration for Act 421 coverage will not occur before January 1, 2022. Anyone applying before that date will only be considered for existing Medicaid programs. Visit http://www.ldh.la.gov/act421 for additional information and answers to frequently asked questions.