What is the LaCHIP Affordable Plan?
The LaCHIP Affordable Plan is a LaCHIP health insurance plan for uninsured children in moderate-income families whose income is too much to qualify for regular LaCHIP but whose gross income is below 250 percent of the Federal Poverty Level (FPL). The regular LaCHIP plan only covers uninsured children in families with countable income up to 200 percent of the FPL. A monthly premium is charged for each household that has at least one child enrolled in the LaCHIP Affordable Plan.
How much will the LaCHIP Affordable Plan cost my family?
The premium is $50 per month per household
There are no premiums due for any household that has at least one LaCHIP Affordable Plan child who is a verified member of a federally recognized Native American tribe or is an Alaskan native.
Who qualifies for the LaCHIP Affordable Plan?
Children must be under age 19 and not covered by health insurance. Family income cannot be more than 250 percent of the Federal Poverty Level. For example, for a family of four, this means an annual income of around $58,800.
Are there any groups that cannot enroll in the LaCHIP Affordable Plan?
Families that already have access to insurance through the Office of Group Benefits through their employers are not eligible for the LaCHIP Affordable Plan. However, they are eligible to apply for regular LaCHIP.
How can I apply for the LaCHIP Affordable Plan?
Those interested in applying are encouraged to call the LaCHIP hotline at 1‐877‐2LaCHIP (252‐2447) or at any of the DHH Medicaid/LaCHIP Eligibility offices or Certified Medicaid/LaCHIP application centers throughout the state, or can apply online. The LaCHIP Affordable Plan uses the same application as the regular LaCHIP program.
What if I don’t know which program to apply for – LaCHIP or the LaCHIP Affordable Plan?
The application is the same for both LaCHIP plans. The eligibility staff will determine, based on your income and other eligibility factors, which program is right for you.
How will I be billed and make my payments?
DHH Medicaid/LaCHIP will mail the first invoice with the eligibility approval notice. The Office of Group Benefits (OGB) will mail all subsequent invoices on the first day of each month. No payments will be received by DHH Medicaid/LaCHIP staff; OGB will collect all premiums for the LaCHIP Affordable Plan. The first premium payment must be submitted to OGB by sending a check or a money order in the mail. You will be able to enroll your child in a Bayou Health plan once OGB informs DHH that the first LaCHIP Affordable Plan premium has been received.
Are there any other ways for me to pay my bill?
After OGB receives the first payment by mail, your LaCHIP Affordable Plan membership is activated. There are a few payment options once your membership is activated:
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Continue to send a check or a money order monthly. Checks or money orders must be made payable to OGB and mailed to OGB at P.O. Box 66127, Baton Rouge, LA 70896-6127
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Automatically deducted from your bank account. Contact OGB at 1-800-272-8451for more information about automatic bank deductions.
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How will my income be counted in the application process?
Federal restrictions require that the income of individuals enrolling in the LaCHIP Affordable Plan not exceed 250 percent of the Federal Poverty Level (FPL). For that reason, deductions cannot be applied to the program. DHH counts the income of natural or adoptive parents living in the home, and siblings and half‐siblings under 18 (if they are included in the family size and its benefits the child being determined eligible for coverage). We do not count the income of step‐parents, grandparents or caregivers.
Can I have other insurance with the LaCHIP Affordable Plan?
No. The LaCHIP and the LaCHIP Affordable Plans are only available to uninsured children.
Are the medical services covered bythe LaCHIP Affordable Plan the same as regular LaCHIP?
LaCHIP Affordable Plan members receive the same services as regular LaCHIP members. LaCHIP Affordable Plan members only have access to these same benefits as long as the monthly premiums due are timely made.
Are the doctors on the LaCHIP plan the same as the doctors on the LaCHIP Affordable Plan?
LaCHIP Affordable Plan members have the choice to enroll in the same Bayou Health plans as the regular LaCHIP plan members. Contact a Bayou Health representative to find out which plan your doctor is enrolled in.
Is there a waiting period with the LaCHIP Affordable Plan for families who drop health insurance?
Yes. A child applying for the LaCHIP Affordable Plan must be uninsured for the 12 months prior to enrollment.
Are there any exceptions to the waiting period?
Yes. Applicants who lose insurance coverage involuntarily are not subjected to the 12‐month waiting period. Reasons for involuntary loss include:
- Lost insurance due to divorce or death of parent
- Lifetime maximum reached
- COBRA coverage ends (up to 18 months)
- Insurance ended due to lay‐off or business closure
- Changed jobs; new employer does not offer dependent coverage
- Employer no longer provides dependant coverage
- Monthly family premium exceeds 10% of gross income
Consult a LaCHIP customer service agent by phone (1‐877‐252‐2447) or e‐mail (medweb@dhh.la.gov) to discuss your request for exemption.
What happens if a premium is not paid?
When a premium is not paid, the Louisiana Office of Group Benefits (OGB) informs DHH Medicaid/LaCHIP Eligibility of the past due premium. Medicaid will advise the family in writing that the case will be closed. If the premium is not paid within 10 days from the date of this notice, coverage will end. The LaCHIP Affordable Plan membership cannot be reactivated until all past due premiums are paid in full.
What happens if there is a reduction in household income?
If any person in the household has a reduction in income during the eligibility period, they should call their caseworker and report the change. A reduction in income could mean the children are eligible for comprehensive health benefits at no cost through regular Medicaid/LaCHIP. Your child/ren can be placed in a no-cost LaCHIP program as early as the month after you report your income change to your caseworker.
What if I renew my current coverage and my income is too much for regular LaCHIP?
If you are longer eligible for a no-cost LaCHIP program, your children will automatically be evaluated for the LaCHIP Affordable Plan. Your caseworker will contact you to ask if you want to be enrolled in the LaCHIP Affordable Plan, which has costs not in regular LaCHIP. DHH will hold your start date beginning one month after you agree to enroll in the program. The benefits for the membership will activate as soon as OGB notifies DHH that they received your first payment for enrollment in the LaCHIP Affordable Plan.
My child was in the hospital in July and I applied for coverage in July. Will the LaCHIP Affordable Plan help with the July hospital bills?
No. There is no retroactive coverage with the LaCHIP Affordable Plan. Coverage can begin no earlier than the month after your case worker has received everything required to be able to determine your eligibility in the LaCHIP Affordable Plan.
However, your case worker can look at your expenses and determine if you qualify for the "spend-down" medically needy program. This Medicaid program may help cover a portion of bills.
How was the LaCHIP Affordable Plan created?
The push to expand LaCHIP began during the 2007 Louisiana Legislative session when both the House and Senate voted unanimously to expand the income limit of 200 percent to 300 percent of the Federal Poverty Level (FPL). On Feb. 27, 2008, DHH received federal approval to expand LaCHIP.
Why is the income limit for the LaCHIP Affordable Plan 250 percent when the Louisiana Legislature passed a bill expanding it to 300 percent?
An Aug. 17, 2007 directive from the Centers from the Centers for Medicare and Medicaid Services (CMS), the Medicaid governing authority, resulted in Louisiana limiting the expansion to 250 percent.
