LaCHIP Affordable Plan

The LaCHIP Affordable Plan (LAP) is a Medicaid/LaCHIP health insurance plan for uninsured children in moderate-income families whose income is too much to qualify for regular LaCHIP but still below a slightly higher income limit. A monthly premium is charged for each household that has at least one child enrolled in the LAP.

The premium is $50 per month per household. There are no premiums due for any household that has at least one LAP child who is a verified member of a federally recognized Native American tribe or is an Alaskan native.

Children must be under age 19 and not covered by health insurance. There is an income limit based on household size.

Families that already have access to employer insurance through the Office of Group Benefits (OGB) are not eligible for LAP, although they may qualify for other Medicaid programs.

Those interested in applying are encouraged to call the LaCHIP hotline at 1-877-2LaCHIP (1-877-252-2447) or visit any of the Louisiana Department of Health (LDH) Medicaid/LaCHIP Eligibility offices or Certified Medicaid/LaCHIP application centers throughout the state. You also can apply online.

LDH Medicaid/LaCHIP will mail the first invoice with the eligibility approval notice. OGB will mail all subsequent invoices on the first day of each month. OGB will collect all LAP premiums. No payments will be accepted by LDH Medicaid/LaCHIP staff. 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 Healthy Louisiana plan once OGB informs LDH that the first LAP premium has been received.

After OGB receives the first payment by mail, your LAP membership is activated. There are a few payment options once your membership is activated:

1. 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
2. Have payments automatically deducted from your bank account. Contact OGB at 1-800-272-8451 for more information about automatic bank deductions.
3. Pay online at http://www.groupbenefits.org

Federal restrictions require that the income of individuals enrolling in LAP not exceed 255 percent of the Federal Poverty Level (FPL). For that reason, deductions cannot be applied to the program. With some exceptions, modified adjusted gross income (MAGI) methodology is used to determine household size and household income. MAGI counts the income of the tax filer (including the legal spouse, whether claimed or not) and all claimed tax dependents living in the home.

No. LaCHIP and LAP are only available to uninsured children.

LAP members receive the same services as regular LaCHIP members. LAP members only have access to these same benefits as long as the monthly premiums due are made timely.

LAP members have the choice to enroll in the same Healthy Louisiana plans as the regular LaCHIP plan members. Contact a Healthy Louisiana representative to find out which plan your doctor is enrolled in.

Yes. A child applying for LAP must be uninsured for the 3 months prior to enrollment when no exceptions exist.

Yes. Applicants who lose insurance coverage involuntarily are not subject to the three-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 dependent coverage
• Monthly family premium exceeds 9.5 percent of household income.
• Monthly premium for coverage of the child exceeds 5 percent of household income.
• Parent is eligible for advance payment of the premium tax credit for enrollment in a qualified health plan (QHP) through the marketplace because their employer-sponsored insurance plan (ESI) is unaffordable.

The child has special health care needs (for example: a chronic physical, developmental, behavioral or emotional condition) beyond what most children require. Consult a LaCHIP customer service agent by phone (1-877-252-2447) or e-mail (MyMedicaid@la.gov) to discuss your request for exemption.

When a premium is not paid, the Louisiana Office of Group Benefits (OGB) informs LDH 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. LAP membership cannot be reactivated until all past due premiums are paid in full or 90 days have elapsed from the date of closure.

If any person in the household has a reduction in income during the eligibility period, let us know. It 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.

If you are no longer eligible for a no-cost LaCHIP program, your children will automatically be evaluated for LAP. Your caseworker will contact you to ask if you want to be enrolled in LAP, which has costs not in regular LaCHIP. LDH 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 LDH that they received your first payment for enrollment in LAP.

No. There is no retroactive coverage with LAP. Coverage can begin no earlier than the month after your case worker has received everything required to be able to determine your eligibility in LAP. 

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.