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

Childhood Cancer Lantern
Search Saved

Louisiana program

Medicaid for a child with a disability (Family Opportunity Act)

Family Opportunity Act Medicaid offers another coverage route for children with disabilities, including underinsured children.

What it is

Family Opportunity Act Medicaid offers another coverage route for children with disabilities, including underinsured children.

Family Opportunity Act Medicaid can help when ordinary children’s Medicaid has too low an income limit. Unlike Act 421, it counts family income. The disability test and any premium need a separate discussion.

Eligibility rules
  • Your child must be under 19.
  • The chart effective March 1, 2026 lists monthly limits of $5,410 for two people, $6,830 for three, $8,250 for four, $9,670 for five and $11,090 for six. No extra five-percentage-point allowance is added. The worker confirms FOA’s family unit, income calculation and any later table update.
  • Your child must meet the childhood disability test, but not Act 421’s hospital-level care test. If your employer pays at least half of a family plan’s premium, you are expected to keep your child on it.
  • FOA uses SSI income methods. Its family includes the child, natural or legal parents and siblings under 19; stepparents and stepsiblings are excluded. A generic household headcount may not match this unit. The worker confirms current resource rules and what counts as underinsurance.
What you get
  • Medicaid coverage for an eligible child with a disability.
  • A route for children who are uninsured or underinsured.
What the help covers
  • There is no premium up to 200% of poverty. Above that, the family pays $12 to $35 a month, less when your child also has other insurance.
  • The posted combined premium and cost-sharing limit is 5% of family income through 200% of poverty and 7.5% above that. The first premium is due in the month after eligibility. Current child continuous-eligibility protections limit older nonpayment-termination provisions.
If you decide to apply
  1. Ask the hospital financial counselor to include Family Opportunity Act Medicaid in the Medicaid review.
  2. Have the oncology records, current household income and insurance cards ready.

Louisiana Medicaid: 1-888-342-6207 · Official page ↗

After you apply
  • A disability decision normally has an overall 90-day federal limit, with limited documented exceptions. The notice identifies the coverage category and any premium.
Good to know

FOA uses a childhood disability test without Act 421’s institutional-care requirement. The worker can compare the two routes and their different financial rules.

Other details
  • A refusal based on family income does not answer whether Act 421’s separate care test is met.
Official sources
Ask your social worker

“Would Family Opportunity Act Medicaid or Act 421 be a better fit for my child? Could you explain the costs and tradeoffs, then help us apply if either is worthwhile?”

Why I’m asking: I want to understand the disability coverage options above the ordinary children’s income limit.

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 it by name and give the medical records that show the disability.

Your social worker

The oncology social worker files it with the Act 421 request so both are considered.

The care team

Records and letters when the application asks for them.

Who decides
Louisiana Medicaid.
Ask your social worker
“We are over the children's line. Can we be considered for Family Opportunity Act Medicaid as well as Act 421, and what would the premium be?”

How to apply

First step: Ask the Medicaid worker, or the hospital financial counsellor, to add Family Opportunity Act Medicaid to the application by name.

  1. Ask for Family Opportunity Act Medicaid by name alongside Act 421; they are different tests.
  2. Ask the worker to confirm the family premium, hardship relief, current billing notice and coverage arrangement.

Official application / program page ↗

Where it starts: Ask for it by name on the ordinary Medicaid application.

What to gather

  • The oncologist's letter
  • This month's household income
  • Insurance cards, if any

How long: The overall federal disability-application decision limit is normally 90 days, with limited documented exceptions. The first premium under the posted FOA rule is due in the month after eligibility.

What a yes looks like

A Medicaid card for the child, and a written answer about any premium.

What a no looks like, and the next move

If the answer is income, Act 421 is the route that leaves parents' income out. If it is the disability test, ask what evidence was missing.

Watch out

  • The posted FOA rule, amended January 2009, sets no family premium through 200% of poverty. Above 200% through 250%, it is $12 monthly with creditable insurance or $30 without; above 250% through 300%, $15 with or $35 without. Current invoices, hardship relief and child continuous-eligibility safeguards require a program check.
  • Ask for this and Act 421 in the same conversation; one counts your income and the other does not.

Dates that change this

2026-09-10: The posted FOA rule, amended January 2009, sets no family premium through 200% of poverty. Above 200% through 250%, it is $12 monthly with creditable insurance or $30 without; above 250% through 300%, $15 with or $35 without. Current invoices, hardship relief and child continuous-eligibility safeguards require a program check. (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

Medicaid for a disabled child with family income up to $8,250 a month for four, $6,830 for three and $5,410 for two.

  • $8,250/month — Household of 4, Family Opportunity Act line (300% of poverty, no allowance added)
  • $6,830/month — Household of 3, Family Opportunity Act line
  • $5,410/month — Household of 2, Family Opportunity Act line
  • $9,670/month — Household of 5, Family Opportunity Act line
  • $11,090/month — Household of 6, Family Opportunity Act line

Covers: Louisiana Medicaid cover for the child, behind private insurance where there is some

What it costs the family: The posted FOA rule, amended January 2009, sets no family premium through 200% of poverty. Above 200% through 250%, it is $12 monthly with creditable insurance or $30 without; above 250% through 300%, $15 with or $35 without. Current invoices, hardship relief and child continuous-eligibility safeguards require a program check.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
At or below 300% of poverty, without an added five-point allowance, using SSI income methodology. The FOA family includes the child, natural or legal parents and siblings under 19, excluding stepparents and stepsiblings. The worker confirms current resource rules.
Disability
The child must meet the SSI childhood disability standard. Institutional level of care is not an FOA requirement.
Insurance status condition
The child must be uninsured or underinsured. Available employer insurance must be taken when the employer pays at least 50% of the annual premium. Enrollment alone does not establish underinsurance or that contribution test.

The trap: The posted FOA rule, amended January 2009, sets no family premium through 200% of poverty. Above 200% through 250%, it is $12 monthly with creditable insurance or $30 without; above 250% through 300%, $15 with or $35 without. Current invoices, hardship relief and child continuous-eligibility safeguards require a program check.

Where I read this

← Back to your options