Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Louisiana program

Medicaid without counting parents’ income (Act 421)

Act 421 offers Medicaid to children with disabilities who need hospital or nursing-level care at home.

What it is

Act 421 offers Medicaid to children with disabilities who need hospital or nursing-level care at home.

Act 421 can open Medicaid when parents’ income is too high for ordinary children’s coverage. The decision depends on your child’s care needs and finances. A cancer diagnosis alone does not establish the required care level.

Eligibility rules
  • Your child must be under 19 and meet the disability rules.
  • Your child must need hospital, skilled-nursing-facility or intermediate-care-facility care. Care at home must be appropriate and cost less than institutional care.
  • The child’s countable resources must be within the SSI limit, currently $2,000 for one child. Not every account or asset necessarily counts; the Medicaid worker checks ownership, availability and exclusions.
  • The child’s own countable income is tested against the long-term-care special income level, $2,982 a month in 2026. Parents’ income and resources do not count for this route. The worker must check the child’s income sources and any allowed exclusions.
What you get
  • Full Louisiana Medicaid services after approval.
  • Parents’ income and savings excluded from the financial test.
  • Access to separately approved home nursing and rides.
What the help covers
  • Act 421 provides Medicaid state-plan services. Before estimating costs, the financial counselor can confirm the child’s coverage arrangement, any allowed family charges and whether each doctor, hospital and pharmacy participates in that arrangement.
If you decide to apply
  1. Ask the hospital social worker to request Act 421 through the ordinary Medicaid application.
  2. Ask the oncology team to describe daily care in tasks and hours for the forms packet.
  3. Have information about your child’s own income and accounts ready.

Louisiana Medicaid, with the local Human Services District reviewing the level of care: 1-800-230-0690 · Official page ↗

After you apply
  • Louisiana Medicaid decides financial eligibility. The local Human Services District reviews the level of care.
  • Disability applications normally have an overall 90-day federal decision limit, with limited documented exceptions. An annual review separately checks the required care level and home-care cost comparison.
  • Two offices decide: Medicaid checks the finances and the local Human Services District checks the care level. Ask the social worker to track which office has the packet and what is missing.
Good to know

The $2,000 resource test concerns your child, but not every asset necessarily counts. The Medicaid worker checks ownership, access and exclusions.

Other details
  • The financial counselor can confirm the child’s coverage arrangement, participating cancer team and existing treatment approvals. Act 421 does not automatically have the same network or billing arrangements as another Medicaid category.
  • Family Opportunity Act Medicaid is another disability route, but it counts family income.
  • Existing private insurance does not automatically disqualify your child. Louisiana’s Act 421 law includes participation in premium-payment assistance to maximize private coverage. The worker can explain the requirements for your child’s plan.

Federal background: Katie Beckett and TEFRA Medicaid options.

Official sources
Ask your social worker

“Could my child’s daily care needs meet Act 421’s rules? What would change about treatment coverage, and could you help us apply if the benefits outweigh the drawbacks?”

Why I’m asking: I want to know whether a disability route can help without counting what parents earn.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for Act 421 by name, return the forms packet, and make sure the daily care is written down.

Your social worker

The oncology team writes the medical picture and the daily care; the social worker chases the review.

The care team

The oncologist and the nurse describe what the child needs each day, in hours and tasks, not just the diagnosis.

Who decides
Louisiana Medicaid decides eligibility; the local Human Services District decides the level of care.
Ask your social worker
“We are over the income line. Can we apply for Act 421, the Children's Medicaid Option that leaves parents' income out, and can the team write down the hands-on care my child needs each day?”

How to apply

First step: Ask for Act 421 by name on the Medicaid application or call 1-800-230-0690, and ask the oncology team to write down the daily care this week.

  1. Ask for Act 421 by name on the Medicaid application, and say the family is over the ordinary line.
  2. Ask the oncology team to write down the daily care in hours and tasks before the level-of-care review.
  3. Ask what the review takes and whether there is any premium.

Official application / program page ↗

Where it starts: Start with the ordinary Medicaid application and ask for Act 421 by name. The state page says a packet of forms follows.

What to gather

  • The oncologist's letter describing daily care in hours and tasks
  • Any account in your child's own name
  • Your child's identification and Social Security number

How long: The overall federal disability-application limit is normally 90 days, with limited documented exceptions. It does not restart at each referral. Care level and comparative home-care cost are reassessed annually; the worker confirms any stage-specific deadline.

What a yes looks like

A Medicaid card for the child with the parents' income left out of the budget, and a level-of-care decision on file.

What a no looks like, and the next move

If the answer is the level of care, ask exactly which daily tasks were not counted and appeal by the date on the notice. If it is the child's own assets, ask what was counted.

Watch out

  • The diagnosis alone is not the test: the law asks for a hospital or nursing-home level of care given at home.
  • The $2,000 ceiling concerns the child’s countable resources. Ownership, availability and exclusions require review before deciding whether an account counts.
  • The Medicaid worker confirms the current Act 421 coverage arrangement. The financial counselor checks participating doctors, hospital, pharmacy and existing approvals before a change. Current fee-for-service assignment was not independently verified in the September 17, 2026 review.

If they say no, quote this: Act 421 Children's Medicaid Option, R.S. 46:977.24: the TEFRA option covers all Medicaid state plan services for a child who is ineligible when the parents' income is considered.

Dates that change this

2026-09-10: The September 17, 2026 review supports the $2,982 monthly countable-income calculation for 2026 and the $2,000 countable-resource test. Current charges, delivery assignment and stage-specific clinical-review instructions still need Medicaid confirmation. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full Louisiana Medicaid state plan services for a disabled child, with parents' income left out of the test.

  • $2,000 — Child’s countable resources under the SSI resource test; parents’ resources excluded

Covers: Every Louisiana Medicaid state plan service · Extended skilled nursing and personal care at home once approved · Rides to appointments

Legal protection: Parents' income is not counted · Parents' assets are not counted

What it costs the family: Louisiana Medicaid confirms any allowed Act 421 premium or cost sharing. The September 17, 2026 review did not independently verify a current category-specific charge schedule.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
The child’s countable income is compared with the special long-term-care income level: three times the federal benefit rate, or $2,982 monthly in 2026. Parents’ income does not count. The worker checks income sources and applicable exclusions.
Assets
The child’s countable resources must be no more than $2,000. Parents’ resources do not count. The worker checks ownership, availability and exclusions; an account balance alone does not establish countability.
Level of care
hospital, skilled nursing facility or intermediate care facility level, with care at home appropriate
Cost test
care at home must cost less than institutional care
Statute refs
R.S. 46:977.24

The trap: A leukaemia diagnosis on its own is not the test. The statute asks for an institutional level of care, and the state page says a local Human Services District reviews the child's needs to decide. Ask the oncology team to write the daily care down, in hours and tasks, before that review.

Where I read this

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