Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 17 - Children's Special Health Services (CSHS) › Chapter 51 - Eligibility for Service Level IV › Section V-5101 - Eligibility Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Eligibility
				  shall be based on two factors, medical eligibility and financial eligibility.
				  This determination shall be made by the designated statewide CSHS Regional
				  Staff . To be eligible to receive direct medical services, the applicant:
1. must reside in the State of
				  Louisiana;
2. must not have reached
				  his/her 21st birthday;
3. must have
				  a condition for which the Program provides treatment services and must be
				  reasonably expected to benefit from the services;
4. must be a member of a family who meets the
				  financial eligibility criteria to receive services. Financial eligibility is
				  based upon three (3) criteria; family size, income(s) and resource(s). All
				  three criteria must be met in order for an applicant to be financially
				  eligible.
a. Family Size. Family size shall
				  be defined as the number of persons living together and related to the
				  applicant by blood, marriage and/or legal adoption and supported by reported
				  income. Foster parents are not to be counted as family members. If a child is
				  in a foster placement and is in the custody of the Department of Health and
				  Hospitals, or Department of Social Services, he shall be considered a family of
				  one.
i. In situations of divorce, blended
				  families, etc., the legal custody decree shall be considered as the rule in
				  determining family size and income.
ii. A parent or step-parent required by a
				  legal custody decree to pay child support to a child/children residing outside
				  the family home is allowed to subtract the amount of the annual child support
				  payment from the applicant's family gross income.
iii. Unusual family situations will be
				  forwarded in writing to the CSHS Administrative Unit for
				  consideration.
b. Family
				  Income. Family income shall be defined as the total annual cash receipts from
				  all sources before taxes. (Income data for a part of a year may be annualized
				  in order to determine eligibility -for example, multiply by four the amount of
				  income received during the most recent three months). Income includes money,
				  wages, and salaries before any deductions, but does not include food or rent
				  received in lieu of wages. Income also includes regular payments from Social
				  Security, Railroad Retirement, unemployment compensation, strike benefits from
				  union funds, veterans benefits, public assistance (including Aid to Families
				  with Dependent Children and Supplement Security Income), alimony, child
				  support, and military family allotments or other regular support from an absent
				  family member or someone not living with the family, private pension,
				  government employee pensions, cash gifts, regular insurance or annuity
				  payments, and income from dividends, interest, rent, royalties, or periodic
				  receipts from estates or trusts.
i. Excluded
				  from family income are non-cash benefits, such as employer or union paid health
				  insurance or other fringe benefits, food or rent received in lieu of wages, the
				  value of food produced and consumed on farms, and state entitlement programs
				  such as Family Subsidy,(Cash Subsidy, Family Support).
ii. Accumulated family medical payment for
				  bills not paid by insurance for the previous 12 months will be deducted from
				  the annual income before eligibility is determined. The annual medical
				  insurance premium paid by the family will also be subtracted from the gross
				  income.
iii. All income must be
				  verified by check stubs, previous year federal income tax form, statement from
				  employer, and/or, upon request, other appropriate documents.
c. Family Resource. Family
				  resources shall be defined as assets or possessions which a family can apply
				  (directly or by sale or conversion) to meet needs. Resources for consideration
				  in determining resource eligibility are as follows:
i. bank accounts (checking and savings; joint
				  and individual);
ii. promissory
				  notes;
iii. time
				  deposits;
iv. mortgages held by
				  applicant and/or family( only those from which income is derived);
v. mutual fund shares;
vi. municipal, corporate and government
				  bonds/stocks;
vii. excess property
				  (other than primary home);
viii.
				  undivided estate ( if the disposing of property is not within the control of
				  the family, then it will not be considered);
ix. trust;
x. mineral rights;
xi. power-driven conveyances (not used in
				  business, farming or other income producing activity. If the vehicle is not
				  used for necessary transportation, it is considered personal property countable
				  at equity value. Examples are motor homes, trailers, campers and boats.) The
				  family is allowed two vehicles per family unit;
xii. lump sum settlements (structured or
				  lump), awards or winnings;
xiii.
				  crops in storage;
xiv. IRA and
				  Keogh Plans (when another retirement option is also available). Resources
				  include assets held individually or in joint names to which the family has
				  unrestricted access.
d.
				  Resource exclusions are as follows:
i. burial
				  insurance and/or funds set aside for burial
ii. term life insurance;
iii. home and contiguous property;
iv. vehicle(s) used for necessary
				  transportation;
v. Resources to
				  which a person rather than the family holds the usufruct, i.e. designated
				  trust.
e. The maximum
				  allowable resource limits for CSHS are as follows:
i. $4,000 for individual;
ii. $5,000 for two;
iii. $6,000 for three;
iv. add $1,000 for each additional family
				  member.