A child must meet the program’s eligibility conditions, including income limits and certain insurance-related conditions, and can lose eligibility if the premium is not paid or if the child is in detention custody.
§977.5. Eligibility requirements A. To be eligible for this program, a child shall: (1) Be ineligible for medical assistance under the Louisiana Medicaid program or benefits under LaCHIP. (2) Be in a family in which the family income is between two hundred percent and three hundred percent of the applicable federal poverty guideline as published in the Federal Register by the United States Department of Health and Human Services. (3) Meet at least one of the following requirements: (a) Be without health insurance for a period of time set forth in rules promulgated by the department. (b) Have a parent who has lost employment and health insurance, which leaves the child without available, affordable dependent health insurance coverage, until such time as affordable employer-sponsored dependent health insurance coverage is again available for the child as set forth in rules promulgated by the department. The department may take into account the affordability of dependent health insurance when determining whether employer-sponsored dependent health insurance coverage is available upon reemployment of a child's parent. (c) Be a newborn whose responsible party does not have available, affordable private or employer-sponsored health insurance. (d) Have lost medical benefits under the Louisiana Medicaid program or LaCHIP within one year of applying for coverage under this Part. B. A child who is determined to be eligible for the program shall remain eligible for twelve months. C. A child shall not be eligible for coverage under the program if: (1) The premium required by R.S. 46:977.9(D) has not been timely paid. If the required premium is not paid, the liability of the program shall be limited to healthcare services provided under the program for the time period for which the premium has been paid. A child shall also be ineligible for reenrollment for a period of time set forth in rule by the department if the premium is not paid. (2) The child is in the custody of a juvenile detention facility or adult correction facility. Acts 2007, No. 407, §1, eff. July 10, 2007; Acts 2018, No. 206, §5.