§977.24. Eligibility factors; benefits; premium payment program participation

            A. In order to be eligible for the TEFRA option, a child shall meet all of the following eligibility criteria:

            (1) He is a Louisiana resident and United States citizen.

            (2) He is under the age of nineteen.

            (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 two thousand dollars in value.

            (6)(a) 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.

            (b) A child may meet a level of care if, within the last twelve months, he presents for emergency care in a hospital more frequently than once per month and the use of the hospital is medically necessary to stabilize sickle cell anemia.

            (7) The cost of his care provided at his home is less than the cost of institutional care.

            B. The TEFRA option shall provide to eligible children coverage for all Medicaid state plan services.

            C. To the maximum extent practicable, as determined by the secretary, 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.

            Acts 2019, No. 421, §1; Acts 2025, No. 294, §1.