Federal, exists in every state
Medicaid without counting parents’ income (Act 421)
Louisiana’s Act 421 option can cover a child with heavy care needs without counting parents’ income.
What it is
Louisiana’s Act 421 option can cover a child with heavy care needs without counting parents’ income.
Louisiana offers Act 421 for a disabled child who needs hospital, skilled-nursing or intermediate-care-facility-level care. Care at home must be appropriate and cost less. A cancer diagnosis alone does not settle those tests.
Eligibility rules
- Your child must be under 19 and meet the disability and institutional care-level tests. Home care must be appropriate and less costly than institutional care.
- Act 421 tests the child’s countable resources against $2,000, leaving parents’ income and resources out. Ownership, availability and exclusions matter; total account balances alone do not establish a failure.
- The posted Louisiana rule uses the special long-term-care income level: three times the $994 federal SSI rate, or $2,982 a month in countable child income for 2026. The worker confirms disregards, account treatment and the current premium and cost-sharing rules. Existing private coverage requires coordination rather than automatic exclusion. R.S. 46:977.24(C) directs premium-payment-program participation to maximize private coverage where practicable.
What you get
- Full Medicaid when the disability, care-level and child-finance rules are met.
If you decide to apply
- Ask the hospital’s enrollment specialist about Act 421 with the ordinary Medicaid application.
- Ask the care team to describe daily tasks, hours and why care at home is appropriate.
Louisiana Medicaid, 1-888-342-6207 · Official page ↗
If you decide to apply
- Louisiana Medicaid identifies the forms and clinical reviewer for an Act 421 request. The overall disability-application standard is generally 90 days, subject to documented unusual circumstances, rather than a new clock each time a packet changes offices. The worker confirms outstanding evidence and any delay. The posted rule requires annual care-level and home-versus-institutional cost reassessments.
Good to know
Parents’ income and savings are excluded, but your child’s own finances still matter.
Other details
- A disability finding and a care-level finding are different tests. A comparison of state benefits is not a reason to move.
Related Louisiana card: Medicaid that does not count parents’ income (Act 421).
Official sources
“What are the benefits and drawbacks of Act 421 for our child, and could you help us decide whether to request the care assessment?”
Why I’m asking: We want to know whether our child’s daily care needs qualify without counting our income.
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 the application paperwork this week, gather the child's own account balances, and get it filed within two weeks with fresh signatures.
Your social worker
Gets the application paperwork, sends the level-of-care form to the right clinician, and checks the signatures are current when it goes in.
The care team
Writes the level-of-care description: every daily task, how often, and what happens without it.
- Who decides
- The state Medicaid agency's disability review
- Ask your social worker
- “Can you help me apply for Katie Beckett (TEFRA)? Who on the team writes the level-of-care application paperwork, and how soon can it go in?”
How to apply
First step: Ask the social worker for the state's Katie Beckett application paperwork this week and who on the team writes the level-of-care section.
- Get the state packet this week.
- Have the clinician describe every daily task and what happens without it.
- File in the first two weeks. Coverage reaches back to the application month.
Where it starts: State TEFRA/Katie Beckett application
What to gather
- Pathology report and oncologist's letter with diagnosis and relapse dates
- The doctor's and nurse's description of daily skilled care (line care, medicines, monitoring)
- The child's own accounts (the child's money is tested, usually at $2,000)
How long: Up to 90 days by federal rule for a disability application. File in the first two weeks so coverage reaches back to the application month.
What a yes looks like
Medicaid on the child's own record, no premium in most states, with a level-of-care end date on the letter.
What a no looks like, and the next move
“Level of care not met”: the doctor's description of daily care decides it. Ask what was missing, add the log, and appeal within the notice's period.
Watch out
- Not every state has it. TEFRA states: AK, DC, DE, GA, ID, LA, ME, MA, MI, MN, MS, NE, NV, NH, OK, RI, SC, SD, WV, WI. Texas and California use other options. The state item explains.
- The application paperwork expires: signatures usually have to be recent when it reaches the reviewer. Do not let it sit at the clinic.
- A child on maintenance can be re-reviewed at the next level-of-care date. Ask when that date is.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 7, 2026.
What it is worth
Full Medicaid on the child's own record, usually with no premium, regardless of parents' income.
Covers: Full state Medicaid benefits · EPSDT home nursing and equipment once enrolled
Legal protection: The test is disjunctive: hospital, nursing facility or ICF level of care. Any one suffices
What it costs the family: No premium in most states. Nevada charges by income.
The eligibility facts, as published
- State option required
- yes
- Child at home
- yes
- Parental income
- not counted
- Child resource limit
- usually $2,000
- Level of care
- hospital, nursing facility or ICF/IID; any one
- Disability
- SSI medical standard where applicable: documented acute leukemia meets listing 113.06A for at least 24 months from diagnosis or relapse, or at least 12 months after transplant, whichever is later; the agency still verifies evidence
Decisions this site cannot make: Disability · Institutional level of care · Cost-effectiveness (some states)
Expect friction on: Detailed medical packet with recent signatures · Re-review at the level-of-care date
The trap: The level-of-care test is separate from the disability test: the child must need the care of a hospital, a nursing facility, or an intermediate-care facility, any one of them. The doctor's description of daily care decides it, not the diagnosis.
What changes by state: Whether it exists, the name (Georgia calls it the Deeming Waiver), the premium (none in most. Nevada charges), the level-of-care form and how long a letter is valid.
Where I read this
- Medicaid Program — Centers for Medicare & Medicaid Services, read August 27, 2026
- Full List of Medicaid Waivers and Programs — Kids’ Waivers, read August 27, 2026
- 42 CFR 435.912: Timely determination of eligibility — Cornell LII (eCFR mirror), read September 7, 2026