If you’re a parent with a higher income, you may find that your family doesn’t qualify for Medicaid. This can be particularly discouraging if you have a child with disabilities, as private insurance benefits often come up short. If you’re in this spot, you may fear that you have no other option for covering your children’s medical expenses. But that may not be the case.
Help may be available through the Children’s Medicaid Option (CMO)/TEFRA. This article will cover the basics of this Medicaid option, how to apply, and more.
What is the Children’s Medicaid Option (CMO)/TEFRA?
Act 421 – Children’s Medicaid Option (CMO) is the product of TEFRA, the Tax Equity and Fiscal Responsibility Act. The latter is the federal law that made the Act 421 program possible.
What’s different about Act 421 is that eligibility for the program doesn’t depend on how much a child’s family makes. This distinction opens the doors of Medicaid to families that would otherwise have had to go without coverage.
The act went into effect January 1, 2022.
The act aims to provide care and resources to keep children with disabilities from having to consume long-term institutional care. It could enable them to achieve a higher quality of life and enjoy more independence.
Who Qualifies for Act 421 Children’s Medicaid Option (TEFRA)?
If you’re wondering whether your child may qualify for Act 421 under TEFRA, this is the section to read. Here are the eligibility guidelines applicants must meet for approval:
- Must be under the age of 19.
- Must have a disability that meets the requirements in the Supplemental Security Income program of the Social Security Administration. If the child doesn’t have such a disability, their eligibility will be determined case by case.
- Must meet certain level of care requirements.
- The care should be able to be provided at home.
- The care the applicant needs should cost less at home than at an institution.
*This is not an exhaustive list of the eligibility requirements associated with TEFRA. To learn more, read this Medicaid Act 421 resource.
How to Get Act 421 CMO Benefits
To take advantage of Act 421 CMO, you’ll apply for Medicaid on behalf of your child and then go through the enrollment process. Here is an overview of the steps involved:
- Complete a Louisiana Medicaid application for your child to determine initial eligibility. When filling out this application, the main thing to remember is to select “yes” when asked if the child has a disability. This selection will prompt the Act 421-CMO process.
- Have a level of care assessment. Wait for a response via mail. You’ll review the documents and follow the instructions to schedule a level of care assessment. Look for form 90-L and the Social Interview form. Additional paperwork may be needed.
- Wait for a disability determination.
- Go through the enrollment process to obtain a Healthy Louisiana plan.
*Every year, you’ll complete a reassessment to determine whether Act 421 CMO benefits are still necessary for your child.
If you have any questions surrounding Act 421 CMO TEFRA, read this Louisiana Department of Health Medicaid resource. We hope you found the information you were looking for.
