Originally published: . Volume 10, No. 7. Source pages: 7.
Representative Horton's Act 421 creates the option within the Medicaid program for children with disabilities to access Medicaid- funded services regardless of their parents' income.
The new law defines "TEFRA option" as the program authorized under Section 134 of the Tax Equity and Fiscal Responsibility Act of 1982 ("TEFRA") which furnishes Medicaid benefits to children with disabilities who are otherwise ineligible for such benefits because the income of their household exceeds state- established limits for Medicaid eligibility.
Act 421 requires the La. Department of Health (LDH), subject to approval by the federal Medicaid agency, to begin a program within Medicaid to provide health services for the population contemplated under Section 134 of TEFRA. It requires that LDH submit the proposed TEFRA option program to the federal Medicaid agency on or before June 1, 2020.
The law stipulates that the TEFRA option shall offer coverage exclusively through the Medicaid fee-for-service system unless LDH determines that offering TEFRA option coverage to persons enrolled in the Medicaid managed care program would be more cost- effective.
The new law states that in order to be eligible for the TEFRA option, a child shall meet all of the following criteria: (1) He is a La. resident and U.S. citizen. (2) He is under the age of 19. (3) He has a disability that is recognized under the definition of disability utilized in the Supplemental Security Income program of the Social Security Administration, regardless of whether he is eligible to receive benefits under that program. (4) He is ineligible for Medicaid coverage when the income of his parents is considered. (5) Excluding the assets of his parents, he does not have total assets exceeding $2,000 in value. (6) Due to his disability, he requires a level of care provided in a hospital, skilled nursing facility, or intermediate care facility; however, care provided outside of such an institution may be appropriate. (7) The cost of his care provided at his home is less than the cost of institutional care.
The new law requires that to the maximum extent practicable, as determined by the secretary of LDH, the department shall include TEFRA option beneficiaries in its health insurance premium payment program as a means of maximizing private health insurance coverage of Medicaid enrollees.
According to the Legislative Fiscal Office, creating a new Medicaid eligibility group is anticipated to result in a significant increase in Medicaid expenditures in FY 21 and future fiscal years. "The Tax Equity and Fiscal Responsibility Act (TEFRA) authorizes states the option to extend Medicaid coverage to children that meet specific criteria that are not ordinarily eligible for Medicaid due to their parent’s income. The Louisiana Department of Health estimates approximately 1,613 children would be eligible under this new optional program in FY 21, increasing by 1% enrollment annually. Based on an estimated per member per month costs of $1,412, total annual Medicaid payments are estimated to exceed $27 M. The total impact in the first year will depend on how quickly eligible children would be phased into the program."
Efforts to better assist families and children were some of the bills that were put forth this legislative session.
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