My Child Has a Disability, but We Make Too Much for Medicaid. What Are Our Options in Louisiana?

If your child has a disability but your household income is too high for regular Medicaid, there may still be Medicaid coverage options in Louisiana.

Louisiana has several programs with different financial and disability-related eligibility rules. Depending on your child’s age, disability, level of care, household income, insurance coverage and other circumstances, options may include:

• Act 421 Children’s Medicaid Option (TEFRA)
• Family Opportunity Act Medicaid
• LaCHIP or the LaCHIP Affordable Plan
• Developmental Disability Medicaid Waivers
• Other Medicaid eligibility categories that may apply to the child’s individual circumstances

The right pathway is not the same for every child.

Important: This article provides general educational information only. It is not legal, financial, medical, Medicaid eligibility, or benefits-planning advice. Only Louisiana Medicaid and the applicable state authorities can determine whether an individual child qualifies for a particular program.

First: Don’t Assume Your Household Income Ends the Medicaid Discussion

For many Medicaid programs, household income matters.

But Louisiana also has programs specifically designed for situations where a child has a disability and the family’s income is too high for traditional Medicaid eligibility.

The Louisiana Department of Health (LDH) specifically identifies both the Family Opportunity Act and Act 421 Children’s Medicaid Option as potential coverage pathways for children with disabilities in families who may earn too much for other Medicaid programs.

That does not mean every child with a disability qualifies. Each program has separate requirements.

Option 1: Act 421 Children’s Medicaid Option

For some Louisiana families, Act 421 Children’s Medicaid Option, also known as TEFRA, may be one of the most important programs to understand.

Act 421 allows certain children with disabilities to qualify for Medicaid without counting their parents’ income and resources toward the child’s Act 421 financial eligibility. LDH’s updated 2026 FAQ describes the program as providing Medicaid eligibility to qualifying children regardless of parental income and resources.

Who may qualify for Act 421?

LDH currently states that a child must meet requirements including:

• Living in Louisiana
• Being a U.S. citizen or eligible non-citizen
• Being age 18 or younger
• Meeting Social Security’s definition of disability
• Meeting applicable limits on the child’s own income and resources
• Requiring a level of care comparable to care provided in a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities
• Being able to safely receive care at home

What is the 2026 Act 421 income limit?

Act 421 uses a special income limit equal to three times the federal Supplemental Security Income Federal Benefit Rate.

The 2026 SSI Federal Benefit Rate for an individual is $994 per month, making three times that amount:

$2,982 per month

This refers to the child’s applicable countable income, not the parents’ household income.

LDH also states that the child’s countable resources must remain within the applicable SSI resource limit. The federal SSI individual resource limit remains $2,000 in 2026.

These numbers should not be used by themselves to determine eligibility. Act 421 also requires disability and level-of-care determinations.

Does my child have to already receive SSI?

Not necessarily.

Act 421 requires the child to meet Social Security’s definition of disability, but if Social Security has not already made that determination, Louisiana Medicaid can request a disability review as part of the Act 421 process.

Option 2: Family Opportunity Act Medicaid

Another important pathway is the Family Opportunity Act (FOA) Medicaid Buy-In Program.

FOA is specifically intended for children with disabilities whose families have too much income to qualify for regular Medicaid or LaCHIP.

Unlike Act 421, FOA does consider family income. However, it allows families with higher incomes to buy into Medicaid coverage.

LDH’s current policy states that FOA covers qualifying children with disabilities under age 19 in families with income at or below 300% of the Federal Poverty Income Guidelines, subject to the program’s eligibility rules.

2026 Family Opportunity Act income limits

Effective March 1, 2026, LDH lists these monthly limits:

Depending on household income and other circumstances, a monthly premium may apply under the Family Opportunity Act program.

FOA eligibility also involves disability and other program requirements, so being below the applicable income figure does not by itself establish eligibility.

Learn more about Family Opportunity Act Medicaid

Act 421 vs. Family Opportunity Act: What’s the Difference?

The programs sound similar because both can help children with disabilities whose families may make too much for traditional Medicaid.

But they work differently.

For a child with significant support needs whose parents earn substantially above ordinary Medicaid limits, Act 421 may be particularly important to investigate because parental income is excluded from its financial determination.

That is not the same as saying the child will qualify. The level-of-care and disability requirements are significant parts of the Act 421 process.

Option 3: LaCHIP

A child does not have to qualify through a disability-specific Medicaid category in order to receive Medicaid coverage.

Louisiana’s Children’s Health Insurance Program, LaCHIP, provides health coverage to qualifying children under age 19.

For 2026, LDH lists the following monthly LaCHIP income limits:

LaCHIP has additional requirements, including rules regarding the child’s age and health insurance status.

Option 4: LaCHIP Affordable Plan

If family income is too high for regular LaCHIP, the LaCHIP Affordable Plan may be another possibility for an uninsured child.

LDH describes the LaCHIP Affordable Plan as coverage for uninsured children in moderate-income families whose income exceeds the regular LaCHIP limit but remains within the Affordable Plan limit.

For 2026, LDH lists these monthly income limits:

LDH currently states that the LaCHIP Affordable Plan has a $50 monthly premium per household when at least one child is enrolled, subject to specified exceptions.

Unlike Act 421 and FOA, LaCHIP Affordable Plan is not specifically a disability program.

What About a Medicaid Waiver?

For some children with intellectual or developmental disabilities, Louisiana’s OIDD waiver system may provide another Medicaid pathway.

Louisiana specifically notes that developmental disability waiver programs can provide Medicaid and additional services to eligible individuals, including some whose income may be too high for other Medicaid programs.

However, a waiver is not simply an alternative application families can use whenever they are over the Medicaid income limit.

A child must first meet OIDD eligibility requirements and, when waiver services are needed, may be placed on the Developmental Disability Request for Services Registry (RFSR).

Waiver opportunities are then offered based on factors including the person’s urgency of need and available funding. LDH states that the full waiver application process does not begin until a waiver opportunity becomes available.

For children, the applicable OIDD waiver system may include the Children’s Choice Waiver or another waiver appropriate to the person’s needs.

Being placed on the RFSR does not itself mean that a child has Medicaid coverage or has been approved for a waiver.

Does EPSDT Help a Child Qualify for Medicaid?

This is an important distinction:

EPSDT is not a separate Medicaid eligibility program.

EPSDT—Early and Periodic Screening, Diagnostic and Treatment—is the federal Medicaid benefit available to Medicaid-eligible children and young adults under age 21.

In other words, a child generally must first become Medicaid eligible through an applicable Medicaid pathway.

Once enrolled in Medicaid, EPSDT provides broad protections for medically necessary services for individuals under age 21. Louisiana’s EPSDT guidance states that if a service is permitted under federal Medicaid law and is medically necessary to correct or improve a physical or mental condition, it must be covered subject to applicable federal Medicaid restrictions.

Depending on medical necessity and program requirements, Medicaid services for children can include areas such as:

• Personal care services
• Nursing
• Medical equipment and supplies
• Therapy
• Behavioral health services
• Transportation
• Other medically necessary Medicaid-covered services

So if a family says:

“We need EPSDT, but we make too much for Medicaid.”

The first question is generally which Medicaid eligibility pathway may be available to the child.

Act 421 and Family Opportunity Act are particularly relevant to that question.

What If My Child Already Has Private Health Insurance?

Private insurance does not necessarily mean that a child with a disability cannot also qualify for Medicaid.

For example, Louisiana’s Family Opportunity Act specifically serves uninsured or underinsured children with disabilities, and current FOA policy contains rules addressing employer-sponsored insurance.

Act 421 participants may also have private insurance.

Medicaid is generally the payer of last resort when other health coverage exists, meaning applicable private insurance is billed before Medicaid for covered services. LDH’s updated 2026 Act 421 FAQ specifically addresses children who maintain private health insurance.

What is LaHIPP?

A Medicaid-eligible child who has access to private health insurance may also potentially qualify for the Louisiana Health Insurance Premium Payment Program (LaHIPP).

If a family qualifies, LaHIPP may reimburse qualifying job-based or individual health insurance premiums and certain other health care costs while the individual remains Medicaid eligible.

LaHIPP has its own eligibility requirements.

Which Program Should We Apply For?

Families do not necessarily need to determine the correct Medicaid category themselves before applying.

Louisiana Medicaid’s eligibility policy directs workers to explore eligibility for applicable Medicaid programs, including programs that provide full Medicaid benefits without premiums before considering certain buy-in programs such as FOA.

When completing a Medicaid application for a child with a disability, it is important to accurately identify that the child has a disability.

For Act 421 specifically, LDH instructs families applying online to identify the child as disabled on the Medicaid application so the application can be considered through the appropriate process.

Families can apply for Louisiana Medicaid online or contact Medicaid Customer Service for assistance.

Apply for Louisiana Medicaid

Louisiana Medicaid Customer Service: 1-888-342-6207

For questions specifically about Act 421 Children’s Medicaid Option, LDH lists:

Act 421: 1-800-230-0690

The Bottom Line

If your child has a disability and your family has been told that you “make too much for Medicaid,” that does not necessarily mean there are no Medicaid options available.

Depending on your circumstances:

• Act 421 may allow a qualifying child with significant care needs to receive Medicaid without counting parental income and resources.
• Family Opportunity Act Medicaid may allow families with higher household income to buy into Medicaid coverage for a qualifying child with a disability.
• LaCHIP or the LaCHIP Affordable Plan may provide coverage depending on household income and other requirements.
• OIDD Medicaid waivers may provide Medicaid and additional services to qualifying children with developmental disabilities when a waiver opportunity is available.

And once a child is Medicaid eligible, EPSDT may provide access to a broad range of medically necessary Medicaid services for individuals under age 21.

The programs have different rules, and a child’s diagnosis or family income alone does not determine eligibility. When in doubt, Louisiana Medicaid encourages families to apply and allow the state to make the official eligibility determination.

Important Information: This article is intended solely for general educational and informational purposes. It is not legal, financial, medical, Medicaid eligibility, or benefits-planning advice. Nothing in this article guarantees that a child will qualify for Medicaid, Act 421, Family Opportunity Act Medicaid, LaCHIP, a Medicaid waiver, EPSDT services, or any particular service or benefit.

Program rules, income standards and eligibility requirements can change and may apply differently based on individual circumstances. Eligibility, level-of-care determinations, service authorization and Medicaid coverage decisions are made by the Louisiana Department of Health, Louisiana Medicaid, or other applicable government authorities.

Our agency is an independent Louisiana Support Coordination Agency and is not the Louisiana Department of Health, Louisiana Medicaid, the Social Security Administration, or another government agency. References and links to government programs are provided for informational purposes only.