If your child has a disability but your family earns too much to qualify for traditional Medicaid, you may have heard about Act 421 in Louisiana.

Act 421 Children’s Medicaid Option is a Louisiana Medicaid eligibility pathway for certain children with disabilities or significant health care needs. One of its most important features is that parental income and resources are not counted under the Act 421 financial eligibility test.

This can allow some children to qualify for Louisiana Medicaid even when their parents’ income would otherwise be too high.

But there is another important point for Louisiana families:

Act 421 is not a Medicaid waiver.

Act 421 can provide Medicaid coverage, but it does not automatically enroll a child in Children’s Choice, NOW, ROW, Supports Waiver, or another Home and Community-Based Services waiver.

Understanding that difference can make Louisiana’s disability-service system much easier to navigate.

What Is Act 421 Children’s Medicaid Option?

Act 421 Children’s Medicaid Option, commonly called Act 421-CMO or TEFRA, allows certain Louisiana children with disabilities to qualify for Medicaid using special eligibility rules.

Louisiana implemented Act 421 beginning in 2022.

The program is designed for children who:

• Have a qualifying disability;
• Require a sufficiently high level of care;
• Can have their needs safely met at home;
• Meet the child’s financial eligibility requirements; and
• Meet the other Medicaid requirements for Act 421.

Louisiana currently limits Act 421 to children who are 18 years old or younger, in other words, under age 19.

Why Is Act 421 Important for Families?

For many Medicaid programs, household income can determine whether a child qualifies.

That can leave families in a difficult situation:

Their child may have extensive medical, developmental, therapy, nursing, equipment, or personal-care needs, but the parents earn too much for the child to qualify through an ordinary income-based Medicaid category.

Act 421 provides a different pathway.

Under Act 421, Louisiana does not count the parents’ income and resources when applying the Act 421 financial eligibility rules.

Instead, Louisiana considers the child’s applicable countable income and resources along with the program’s disability, level-of-care, residency, citizenship, and other requirements.

This is why Act 421 is sometimes particularly relevant to families searching for:

• Medicaid for a child with a disability in Louisiana
• Medicaid when parents make too much
• TEFRA Medicaid in Louisiana
• Medicaid for a child with autism or developmental disabilities
• Medicaid for a medically complex child
• Louisiana disability Medicaid programs

However, a diagnosis alone does not establish Act 421 eligibility.

Who Qualifies for Act 421 in Louisiana?

Louisiana requires a child to meet all applicable Act 421 eligibility requirements.

Current requirements generally include that the child:

• Is a Louisiana resident
• Is a U.S. citizen or qualified non-citizen
• Is under age 19
• Meets the applicable federal definition of disability
• Meets the child’s income requirement
• Meets the child’s resource requirement
• Meets a qualifying institutional level of care
• Can have their care needs safely met at home
• Meets the other applicable Medicaid eligibility requirements

A child does not automatically qualify simply because they have a medical diagnosis, developmental disability, autism, cerebral palsy, intellectual disability, genetic disorder, or other condition.

The child’s individual disability and functional needs must meet the applicable Act 421 standards.

Does Parent Income Count for Act 421?

No, parental income and resources are disregarded under the Act 421 financial eligibility test.

This is one of the most important features of the program.

A family should therefore not automatically assume that their child cannot receive Medicaid because the parents earn too much money.

Louisiana Medicaid may still evaluate the child under Act 421 or another Medicaid eligibility category.

It is important, however, not to apply this rule to every Medicaid program.

The parental-income disregard is part of the Act 421 eligibility framework. Other Louisiana Medicaid programs have different financial rules.

What Is the Act 421 Income Limit in Louisiana for 2026?

Louisiana currently requires an Act 421 child’s countable income to remain at or below three times the federal Supplemental Security Income Federal Benefit Rate.

For 2026, that equals:

$2,982 per month

This is the income standard applied to the child’s countable income, not the parents’ household income.

It should not be used by itself to determine whether a child qualifies.

Medicaid rules determine what income is countable, and the child must also meet the disability, level-of-care, resource, and other Act 421 requirements.

What Is the Act 421 Resource Limit?

Louisiana currently states that a child’s countable resources must remain within the applicable SSI resource limit.

The current individual resource limit is:

$2,000

Again, this does not mean the parents can have only $2,000 in savings or assets.

The Act 421 financial determination focuses on the child’s applicable countable resources.

Issues involving a child’s:

• Trust
• Settlement
• Inheritance
• Savings account
• Jointly owned property
• ABLE account
• Other financial assets

can involve additional Medicaid rules.

Families should not transfer, retitle, spend, or restructure a child’s assets based solely on general information found online.

What Does “Level of Care” Mean for Act 421?

Act 421 is not based only on finances.

The child must also meet a qualifying institutional level of care.

That does not mean the child must actually live in an institution.

Instead, Louisiana evaluates whether the child’s needs are comparable to the level of care ordinarily provided in one of the qualifying institutional settings while determining that the child’s needs can safely be met at home.

Act 421 recognizes qualifying levels of care associated with:

Intermediate Care Facility for Individuals With Intellectual Disabilities – ICF/IID

This can apply to certain children with significant intellectual or developmental disabilities and substantial functional needs.

Nursing Facility Level of Care

This can apply to children with significant long-term medical or physical needs and substantial limitations in age-appropriate daily functioning.

Hospital Level of Care

This applies when the child’s medical needs meet the applicable hospital-level criteria.

The level-of-care determination is separate from both the child’s diagnosis and financial eligibility.

Does a Child Have to Live in an Institution First?

No.

Act 421 is specifically designed to allow qualifying children to receive Medicaid while living at home.

The child must meet the applicable institutional level-of-care standard, but that does not mean the child must first move into a nursing facility, hospital, or ICF/IID.

Louisiana also requires that the child’s needs can be safely met in the home under the applicable Act 421 requirements.

Is There a Waiting List for Act 421 in Louisiana?

No.

Louisiana’s current Act 421 guidance states that there is:

• No Act 421 waiting list, and
• No fixed cap on the number of qualifying children who can enroll.

That is a major difference between Act 421 and Louisiana’s developmental-disability waiver system.

A child still must complete the eligibility process and satisfy all Act 421 requirements, so the absence of a waiting list does not mean approval is automatic or immediate.

Is Act 421 a Louisiana Medicaid Waiver?

No.

This is one of the most important things families should understand.

Act 421 is a Medicaid eligibility pathway.

Louisiana’s developmental-disability Home and Community-Based Services waivers are separate programs, including:

• Children’s Choice Waiver
• New Opportunities Waiver — NOW
• Residential Options Waiver — ROW
• Supports Waiver

Those waivers provide specific Home and Community-Based Services that are not created simply because a child receives Medicaid through Act 421.

A child can have Act 421 Medicaid without having an OIDD waiver.

Likewise, Act 421 enrollment does not automatically:

• Place a child into Children’s Choice
• Provide a NOW or ROW waiver
• Assign a waiver Support Coordinator
• Create waiver-funded Family Support
• Create respite hours
• Provide Environmental Accessibility Adaptations
• Guarantee any particular waiver service

Act 421 and an OIDD waiver serve different purposes.

Act 421 vs. a Medicaid Waiver

A simple way to understand the difference is:

	Act 421	OIDD Medicaid Waiver
Helps establish Medicaid eligibility	Yes	Medicaid eligibility is part of waiver enrollment
Parental income disregarded under Act 421 rules	Yes	Separate waiver financial rules apply
Requires qualifying level of care	Yes	Yes
Has an Act 421 waiting list	No	Waiver opportunities follow the OIDD priority process
Provides regular Medicaid benefits	Yes	Yes
Provides OIDD waiver-specific HCBS services	No	Yes
Automatically provides Support Coordination	No	Applicable waiver participants receive waiver Support Coordination

This distinction is especially important for families who are waiting for developmental-disability waiver services.

Can a Child Have Act 421 While Waiting for an OIDD Waiver?

Yes.

A child can potentially receive Medicaid through Act 421 while their developmental-disability waiver situation is handled separately.

This can be important because many services available to Medicaid-eligible children are Medicaid State Plan or EPSDT services, not waiver services.

A family does not necessarily have to wait for an OIDD waiver opportunity before the child can potentially qualify for Medicaid through Act 421.

However, eligibility for Act 421 must still be independently established.

What Happens if a Child With Act 421 Gets an OIDD Waiver?

If a child enrolled in Act 421 later receives an OIDD waiver opportunity, the family should follow the waiver application and enrollment process and provide the requested information.

Louisiana’s current Act 421 guidance states that:

Once the beneficiary is actually enrolled in the OIDD waiver, Act 421-CMO enrollment terminates.

This does not mean the child simply loses Medicaid coverage.

Instead, the child’s Medicaid eligibility transitions to the applicable waiver-related pathway when all required conditions are met.

Families should therefore not think of Act 421 and an OIDD waiver as two separate waivers that simply stack together.

What Medicaid Services Can a Child With Act 421 Receive?

Act 421 provides Medicaid coverage subject to Louisiana Medicaid’s normal coverage and authorization requirements.

Because Act 421 beneficiaries are children, applicable Medicaid benefits may include services such as:

• Doctor and hospital care
• Prescription medications
• Behavioral health services
• Occupational therapy
• Physical therapy
• Speech therapy
• Dental services
• Durable Medical Equipment
• Medical supplies
• Home health services
• Nursing services when applicable
• Personal Care Services when requirements are met
• Non-emergency medical transportation
• Other Medicaid-covered services

A child’s Act 421 enrollment does not guarantee approval of every requested service.

Individual Medicaid services may have separate requirements involving:

• Medical necessity
• Prior authorization
• Assessments
• Prescriptions or orders
• Provider qualifications
• Coverage criteria
• Service limits or other program rules

What Is EPSDT, and How Does It Relate to Act 421?

This is another common area of confusion.

Act 421 and EPSDT are not the same thing.

Act 421 is a way certain children can become eligible for Medicaid.

EPSDT, or Early and Periodic Screening, Diagnostic and Treatment, is the federal Medicaid benefit framework for Medicaid members under age 21.

A simple way to think about it is:

Act 421 may help the child obtain Medicaid. EPSDT affects the Medicaid services and protections available to eligible children.

A child does not need an OIDD waiver simply to access every Medicaid service available under EPSDT.

Waiver services and Medicaid State Plan/EPSDT services should be evaluated separately.

Is Act 421 the Same as the Family Opportunity Act?

No.

Louisiana has more than one Medicaid pathway that may be relevant to a child with a disability.

The Family Opportunity Act is a different Medicaid eligibility option with its own financial and program requirements.

Act 421 is Louisiana’s TEFRA pathway and uses the child’s financial circumstances under the applicable Act 421 rules rather than counting parental income and resources.

Families who believe they earn too much for Medicaid should not assume they must determine the correct eligibility category on their own.

Louisiana Medicaid evaluates eligibility under the applicable programs based on the information provided.

What if the Child Already Has Private Insurance?

Private health insurance does not automatically prevent a child from receiving Act 421 Medicaid.

Louisiana’s updated 2026 Act 421 guidance states that families are not required to keep existing private health insurance or obtain new private insurance as a condition of Act 421 enrollment.

If the child does have other health insurance, Medicaid generally follows coordination-of-benefits rules and acts as payer of last resort when another insurer is responsible for a covered service.

Some Medicaid-eligible families with private insurance may also be evaluated for programs such as the Louisiana Health Insurance Premium Payment Program — LaHIPP when applicable.

How Do You Apply for Act 421 in Louisiana?

The Act 421 process generally involves several separate determinations.

1. Apply for Louisiana Medicaid

Families can apply through Louisiana Medicaid.

When completing the application, it is important to accurately identify that the child has a disability so the appropriate disability-related Medicaid pathways can be considered.

2. Complete the Level-of-Care Process

The applicable Human Services District or Authority assists with the Act 421 level-of-care assessment.

Medical, developmental, functional, or other records may be requested.

3. Complete the Disability Determination if Required

The child must meet the applicable disability standard.

Existing Social Security disability determinations may be relevant in some situations. If an appropriate determination is not already available, additional information may be requested.

4. Medicaid Determines Eligibility

Louisiana Medicaid evaluates the financial and other program requirements.

If all applicable Act 421 requirements are met, the child may be enrolled in Medicaid.

Submitting an application does not guarantee approval.

Does Act 421 Have to Be Renewed?

Yes.

Act 421 eligibility is not necessarily permanent once approved.

Louisiana conducts continued-eligibility reviews.

The child’s level of care is reviewed periodically, and disability or financial information may also need to be reviewed depending on the circumstances.

Families should respond to Medicaid renewal notices and requests for information by the deadlines provided.

What Happens When a Child Turns 19?

Act 421 is for children under age 19.

That means Act 421 itself is not an adult Medicaid eligibility pathway.

However:

Turning 19 does not automatically mean the person cannot have Medicaid.

Louisiana Medicaid may evaluate the individual for another eligibility category depending on the person’s circumstances.

Other disability-related Medicaid pathways, SSI-related eligibility, Medicaid Purchase Plan, waiver-related eligibility, or other categories may become relevant.

For children with intellectual or developmental disabilities, planning for adult services and any applicable OIDD waiver transition should occur separately from Act 421 eligibility.

Families should not wait until the final moment to begin understanding what coverage may apply after Act 421.

Can You Appeal an Act 421 Denial?

Certain Act 421 decisions may carry appeal rights.

Examples can include:

• A determination that the child does not meet the required level of care
• A Medicaid eligibility denial
• Certain service or prior-authorization decisions after enrollment

The correct appeal process and deadline can depend on what decision was made and which entity made it.

Families should follow the appeal instructions contained in the actual written notice they receive rather than relying on a general deadline found online.

Does a Support Coordination Agency Decide Act 421 Eligibility?

No.

An independent Support Coordination Agency does not determine whether a child qualifies for Act 421.

Act 421 financial eligibility, disability determinations, level-of-care findings, Medicaid enrollment, and service authorization are handled by Louisiana Medicaid and the appropriate government entities.

Likewise:

Having Act 421 Medicaid does not automatically mean a child has waiver Support Coordination.

Support Coordination is connected to the applicable program or service for which the person qualifies.

A Support Coordinator who is already involved with a participant through an applicable Medicaid or waiver program may help the family understand relevant services and processes within the scope of that program, but the Support Coordinator does not approve Act 421 eligibility.

Where Can Families Get Official Act 421 Information?

For questions about Act 421 Children’s Medicaid Option, Louisiana currently lists:

Act 421 Children’s Medicaid Option
1-800-230-0690

Email: 421-CMO@la.gov

For general Louisiana Medicaid questions:

Louisiana Medicaid Customer Service
1-888-342-6207

Families should use current Louisiana Department of Health information because Act 421 rules and guidance can change over time.

The Bottom Line: What is Act 421 in Louisiana?

Act 421 Children’s Medicaid Option is a Louisiana Medicaid eligibility pathway for certain children under age 19 with disabilities or significant health care needs who meet a qualifying institutional level of care but can safely receive care at home.

One of its most important features is:

Parental income and resources are disregarded when Louisiana determines financial eligibility under Act 421.

For 2026, Louisiana currently uses:

• $2,982 per month as the child’s applicable income standard; and
• $2,000 as the individual SSI resource limit.

Those numbers alone do not determine eligibility.

The child must also meet the applicable:

• Disability standard
• Level-of-care requirement
• Age requirement
• Residency and citizenship requirements
• Other Medicaid eligibility requirements

And for families involved with Louisiana’s waiver system, remember:

Act 421 is Medicaid coverage. It is not an OIDD HCBS waiver.

There is no Act 421 waiting list. A child can potentially receive Act 421 Medicaid without having an OIDD waiver, and Act 421 does not automatically provide Children’s Choice, NOW, ROW, Supports Waiver, waiver Support Coordination, or waiver-specific services.

If an Act 421 beneficiary later enrolls in an OIDD waiver, current Louisiana guidance states that the Act 421 enrollment terminates as the person’s Medicaid eligibility transitions to the applicable waiver pathway.

Understanding that difference is one of the most important steps in navigating Act 421 and Louisiana Medicaid services for a child with a disability.

Important Information: This article is provided solely for general educational and informational purposes. It is not legal, financial, medical, Medicaid eligibility, waiver eligibility, or benefits-planning advice. Nothing in this article determines that a child qualifies for Act 421, Medicaid, EPSDT, an OIDD waiver, Support Coordination, or any particular Medicaid service.

Eligibility depends on the child’s individual financial circumstances, disability determination, level-of-care assessment, age, residency, citizenship or immigration status, and other applicable program requirements. Medicaid services may also require separate medical-necessity reviews, assessments, prior authorization, or other coverage requirements.

Program requirements and financial standards may change. Families should rely on current notices and information from the Louisiana Department of Health and Louisiana Medicaid when making decisions about an individual child’s eligibility or coverage.

Our agency is an independent Louisiana Support Coordination Agency and is not the Louisiana Department of Health, Louisiana Medicaid, OIDD, a Human Services District or Authority, the Social Security Administration, or another government agency. Support Coordination may assist eligible participants with understanding and navigating services within the scope of their applicable program but does not determine or guarantee Act 421, Medicaid, waiver, or service eligibility.