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      RS 46:977.9     


§977.9. Healthcare benefits; cost sharing requirements

            A. Subject to the General Appropriation Act of the legislature, the department shall purchase or provide healthcare benefits for eligible children which are equivalent to the benefits provided for children under the coverage requirements for the federal Children's Health Insurance Program, Title XXI of the Social Security Act.

            B. Subject to the General Appropriation Act of the legislature, as an alternative to the health benefits outlined in Subsection A of this Section, and when cost-effective to the state, the department may provide premium assistance to families toward the cost of privately sponsored health insurance, including employer-sponsored and individually purchased health insurance.

            C. The content and availability of benefits described in Subsection B of this Section and the terms of eligibility for those benefits shall be at the discretion of the department. The department shall determine the efficacy and cost-effectiveness as a means of promoting retention of private or employer-sponsored health insurance. If the department provides benefits described in Subsection B of this Section, the department shall not be required to provide services under any provision of Title XIX or Title XXI of the Social Security Act.

            D. The responsible party for a child enrolled in the program shall be subject to the following cost-sharing requirements for subsidized insurance:

            (1) The department shall by rule establish requirements concerning monthly premiums, co-payments, and coinsurance for healthcare services. This cost sharing shall be on a sliding scale based on family income up to 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. The department shall work in consultation with the Louisiana staff of the Children's Defense Fund, Agenda for Children, Louisiana Maternal and Child Health Coalition, Covering Kids and Families, Louisiana Partnership for Children and Families, Families Helping Families of Louisiana, Louisiana Chapter of the National Association of Social Workers, Louisiana Chapter of the American Academy of Pediatrics, Louisiana Chapter of the March of Dimes, and Louisiana Primary Care Association in the rulemaking process regarding the sliding scale, which is based on family income. Notwithstanding this Paragraph, there shall be no co-payment required for well-baby or well-child health care, including but not limited to age-appropriate immunization as required under state and federal law.

            (2) The responsible party for a child enrolled in a privately sponsored health insurance plan under this Part shall be subject to the cost-sharing provisions stated in the privately sponsored health insurance plan.

            Acts 2007, No. 407, §1, eff. July 10, 2007; Acts 2018, No. 206, §5.

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