Healthy Louisiana is the state's Medicaid managed care program, covering more than 1.9 million Louisiana residents through private managed care organizations (MCOs) including Aetna Better Health, AmeriHealth Caritas, and Molina Healthcare. Losing Healthy Louisiana coverage in 2026 is a significant health coverage disruption, especially as the One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, introduces new work requirement and income verification rules that are accelerating terminations across all 40 expansion states plus Washington D.C. Louisiana residents who lose Medicaid coverage have a 90-day Special Enrollment Period to enroll in an ACA Marketplace plan through healthcare.gov, or they can appeal the termination, re-apply if income still qualifies, or enroll their children in LaCHIP year-round regardless of adult eligibility. The 90-day window is longer than the standard 60-day SEP that applies to most other qualifying life events, including job loss and divorce, giving Louisiana residents more time to compare options and avoid a gap in coverage.
Louisiana expanded Medicaid under the Affordable Care Act in July 2016. Adults ages 19 to 64 with incomes at or below 138% of the Federal Poverty Level qualify, including working adults who previously fell into the coverage gap. For 2026, the Medicaid income limit in Louisiana is approximately $22,025 for a household of one and $45,540 for a household of four. Louisiana does not have a state-based Marketplace; all residents enroll through the federal platform at healthcare.gov. For people with incomes between 138% and 400% FPL ($63,840 for a single person in 2026), the ACA Marketplace offers premium tax credits. The enhanced premium tax credits from the American Rescue Plan Act and the Inflation Reduction Act expired January 1, 2026, so the 400% FPL subsidy cliff has returned: people above 400% FPL receive no ACA subsidy in 2026. This guide covers the exact steps to take immediately, how to compare your options, the documents you will need, and what to expect from the Louisiana Medicaid appeal process.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes Louisiana residents make after losing Healthy Louisiana Medicaid coverage in 2026:
- Waiting on the appeal before applying for Marketplace coverage. Louisiana Medicaid appeals can take 30 to 90 days. Apply for ACA coverage at healthcare.gov the same day you file your appeal. If the appeal succeeds and Medicaid is reinstated, you can cancel the Marketplace plan before its start date.
- Missing the 90-day SEP window. The 90-day clock starts from your termination date, not from when you receive the notice or when you read it. Many Louisiana residents discover their Medicaid lapsed weeks after the termination date, leaving them with a shorter window than expected.
- Not re-checking income against the 138% FPL threshold. Louisiana is a Medicaid expansion state. If your income dropped after the redetermination (due to job loss, reduced hours, or household size change), you may qualify for Healthy Louisiana Medicaid again immediately. Apply at ldh.la.gov year-round.
- Assuming children lose coverage when the adult does. LaCHIP eligibility for children is evaluated separately from adult Medicaid eligibility. Children in Louisiana households may qualify for LaCHIP at incomes up to 212% FPL even when the adult member loses Medicaid. Call 1-877-252-2447 to enroll children separately.
- Reporting last year's income instead of projected 2026 income. ACA Marketplace subsidies use Modified Adjusted Gross Income (MAGI) based on what you expect to earn in 2026, not what you earned in 2025. If your income dropped significantly, project forward and report the lower amount to get the maximum premium tax credit.
- Enrolling in a short-term health plan to save money. Short-term health plans sold in Louisiana are not ACA-compliant, can deny coverage for pre-existing conditions, and create a coverage gap. An ACA Silver plan with cost-sharing reductions is almost always the better financial choice for people between 138% and 250% FPL.
Healthy Louisiana vs ACA Marketplace: Which Coverage Is Right for You?
Healthy Louisiana (Louisiana's Medicaid managed care program) and ACA Marketplace plans serve different income ranges and carry very different cost structures. Healthy Louisiana covers adults with incomes at or below 138% FPL ($22,025 for a single person in 2026) through managed care organizations including Aetna Better Health, AmeriHealth Caritas Louisiana, Healthy Blue Louisiana, Molina Healthcare, and UnitedHealthcare Community Plan. Cost to the member is zero or near-zero: Medicaid charges no premiums for most enrollees and minimal copays (typically $1 to $4 per visit). ACA Marketplace Silver plans, by contrast, carry premiums of $0 to $250 per month after premium tax credits for people between 138% and 400% FPL, with deductibles ranging from $150 (with cost-sharing reductions for incomes under 250% FPL) to $5,000 or more for Bronze plans. The decisive question for Louisiana residents who lose Healthy Louisiana coverage is simple: what is your projected 2026 household income relative to the 138% FPL threshold? People at or below 138% FPL should re-apply for Medicaid at ldh.la.gov immediately rather than pay any Marketplace premium.
Louisiana residents who fall between Medicaid and the Marketplace income limits face a more nuanced decision. For incomes between 138% and 250% FPL ($39,900 single in 2026), ACA Silver plans with cost-sharing reductions can be nearly as comprehensive as Medicaid, with deductibles as low as $150 and out-of-pocket maximums under $3,000. For incomes between 250% and 400% FPL, cost-sharing reductions no longer apply, but premium tax credits still reduce monthly costs substantially. Silver plans in Louisiana parishes typically run $50 to $200 per month after subsidies for people in this income band. Bronze plans cost less per month but carry higher deductibles ($1,700 minimum for HDHPs in 2026 per IRS Rev. Proc. 2025-19), making them riskier for people with ongoing medical needs. Louisiana has not expanded any state-specific Marketplace subsidies beyond the standard federal ACA framework, so healthcare.gov is the only enrollment platform for all 64 Louisiana parishes.
Louisiana Medicaid Work Requirements and OBBBA Changes in 2026
The One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, made two major changes that directly affect Louisiana Medicaid members in 2026. First, starting December 31, 2026, states must redetermine Medicaid expansion adults (ages 19 to 64 without disabilities) every six months instead of annually. Second, work requirements for Medicaid expansion adults are being phased in at the federal level, with Louisiana required to comply by January 1, 2027. Louisiana LDH has published guidance indicating the state will implement community engagement requirements (80 hours per month of work, education, or volunteering) for non-exempt Medicaid expansion adults. Groups exempt from work requirements in Louisiana include people with disabilities or serious medical conditions, pregnant women, primary caregivers of children under 6 or of disabled family members, people ages 19 to 20 enrolled in school, and people ages 60 to 64.
Louisiana residents whose termination notice cites work requirements should file an appeal immediately if they believe they qualify for an exemption. The appeal must be filed before the appeal deadline in the notice (typically within 90 days of the termination date). Exempt individuals can request continuation of Medicaid benefits during the appeal process under 42 CFR 431.231. Louisiana LDH's fair hearing process allows enrollees to present evidence of exempt status, including documentation of disability, medical condition, caregiver status, or school enrollment. Contact the Louisiana Medicaid Fair Hearings Unit by calling LDH at 1-888-342-6207 or visiting ldh.la.gov/medicaid.
Documents Needed to Prove Louisiana Medicaid Loss and Enroll in ACA Coverage
Louisiana residents applying for an ACA Marketplace SEP after losing Healthy Louisiana Medicaid need specific documentation to prove the qualifying life event and establish subsidy eligibility. Healthcare.gov will prompt you to upload these documents within 30 days of selecting a plan. Gather all items before you start the application to avoid delays. Missing or incorrect documentation is the leading cause of SEP denial in Louisiana and other states.
- Louisiana Medicaid termination letter or LDH notice with your termination date clearly stated
- Social Security numbers for yourself and all household members applying for coverage
- Proof of current Louisiana address (utility bill, lease agreement, or bank statement within the last 60 days) for plan availability by ZIP code
- Documentation of projected 2026 household income: recent pay stubs (last 30 days), employer letter, unemployment award letter, or self-employment income records for MAGI calculation
- Birth certificates for dependent children if enrolling them in coverage
- Louisiana Healthy Louisiana member ID number (from your insurance card or LDH records) for identity verification
Louisiana Medicaid Income Limits and ACA Subsidy Thresholds for 2026
Louisiana Medicaid (Healthy Louisiana) covers adults at or below 138% of the Federal Poverty Level (FPL). The ACA Marketplace offers subsidized coverage for incomes between 100% and 400% FPL. The table below shows 2026 income thresholds for Louisiana residents based on household size. Louisiana uses the standard 48-state FPL guidelines; Alaska and Hawaii have higher thresholds. Use the Medicaid income limits reference at /medicaid-income-limits and the ACA income limits reference at /aca-income-limits for more detail.
Louisiana Medicaid (138% FPL) and ACA Subsidy (400% FPL) Income Limits, 2026 (48 contiguous states + DC)| Household size | 138% FPL (Medicaid limit) | 250% FPL (CSR Silver cut-off) | 400% FPL (Subsidy cliff) |
|---|
| 1 | $22,025 | $39,900 | $63,840 |
| 2 | $29,863 | $54,100 | $86,560 |
| 3 | $37,702 | $68,300 | $109,280 |
| 4 | $45,540 | $82,500 | $132,000 |
| 5 | $53,378 | $96,700 | $154,720 |
| 6 | $61,217 | $110,900 | $177,440 |
| 7 | $69,055 | $125,100 | $200,160 |
| 8 | $76,894 | $139,300 | $222,880 |
| Each additional person | + $7,838 | + $14,200 | + $22,720 |
The 400% FPL subsidy cliff returned for 2026 after enhanced PTCs from ARPA and the IRA expired January 1, 2026. People above 400% FPL receive no ACA subsidy. Cost-sharing reductions on Silver plans apply only at or below 250% FPL. Louisiana uses 48-state FPL guidelines. Alaska and Hawaii thresholds are higher.
Source: HHS ASPE 2026 Poverty Guidelines (published January 2026); CMS ACA premium tax credit thresholds
Frequently Asked Questions
How long do I have to enroll in a new plan after losing Healthy Louisiana Medicaid?
You have 90 days from the date your Healthy Louisiana Medicaid coverage ended to enroll in an ACA Marketplace plan through healthcare.gov. This is the loss-of-Medicaid Special Enrollment Period (SEP) and is longer than the standard 60-day SEP for job loss or divorce. The 90-day clock starts from your termination date, not the date you receive or read your notice. Log in to healthcare.gov, select 'I lost qualifying health coverage,' choose Medicaid or CHIP as the type, and enter your Louisiana termination date.
What documents do I need to prove I lost Louisiana Medicaid for a Marketplace SEP?
Healthcare.gov will ask you to upload your Louisiana Department of Health (LDH) termination letter or written notice within 30 days of selecting a plan. The notice must show your name, your Healthy Louisiana member ID, and your termination date. Also gather your Social Security number, proof of your current Louisiana address (utility bill or lease within 60 days), and documentation of your projected 2026 household income (recent pay stubs, employer letter, or unemployment award letter) for MAGI calculation. Missing or delayed documentation is the most common reason SEP applications are denied.
Can I appeal my Louisiana Medicaid termination in 2026?
Yes. Louisiana LDH must provide a fair hearing process for all Medicaid terminations. Submit your appeal request to LDH before the deadline in your termination notice, typically within 90 days of the notice date. Call LDH at 1-888-342-6207 or submit your request online at ldh.la.gov/medicaid. Critically, if you file your appeal before your coverage actually ends, you are entitled to continuation of Medicaid benefits during the appeal under 42 CFR 431.231. File your Marketplace SEP application the same day as your appeal to protect yourself if the appeal takes weeks.
What is the income limit for Healthy Louisiana Medicaid in 2026?
Louisiana Medicaid (Healthy Louisiana) covers adults ages 19 to 64 with household incomes at or below 138% of the Federal Poverty Level. For 2026, that is approximately $22,025 for a household of one, $29,863 for two, $37,702 for three, and $45,540 for a family of four. These are based on Modified Adjusted Gross Income (MAGI). If your income is at or below these thresholds, re-apply at ldh.la.gov year-round. Medicaid enrollment in Louisiana has no deadline.
Do Louisiana's work requirements affect my Medicaid eligibility in 2026?
Louisiana is required to implement OBBBA work requirement rules by January 1, 2027. Under these rules, non-exempt Medicaid expansion adults (ages 19 to 64) must document 80 hours per month of work, education, or volunteering to maintain coverage. Exempt groups include people with documented disabilities or serious medical conditions, pregnant women, primary caregivers of children under 6 or of disabled family members, people ages 19 to 20 enrolled in school full-time, and adults ages 60 to 64. If your termination notice cites work requirements and you believe you are exempt, file an appeal with LDH immediately at 1-888-342-6207.
What if my income is still below 138% FPL? Can I re-apply for Louisiana Medicaid?
Yes. If your income is still at or below 138% FPL ($22,025 single, $45,540 family of four for 2026), re-apply for Healthy Louisiana Medicaid immediately at ldh.la.gov. Medicaid enrollment in Louisiana is year-round with no deadline. If your termination was based on an income calculation that used outdated or incorrect data, re-applying with current income documentation can restore your Medicaid, often within a few weeks. While your re-application is pending, apply for Marketplace coverage through the 90-day SEP as a backup.
Will my children lose their Louisiana Medicaid or LaCHIP coverage when I lose mine?
Not necessarily. Children's eligibility for Medicaid and LaCHIP (Louisiana's CHIP program) is evaluated separately from adult eligibility. Louisiana children up to age 19 can qualify for LaCHIP at household incomes up to 212% FPL, which is about $34,160 for a household of one adult and one child. LaCHIP enrollment is year-round with no deadline. Call 1-877-252-2447 or apply at ldh.la.gov/lacommunity to enroll your children separately. Children with incomes above 212% FPL may still qualify for ACA Marketplace coverage during the same 90-day SEP that applies to adults.
Does the 2026 ACA subsidy cliff affect Louisiana residents switching from Medicaid to the Marketplace?
Yes, for incomes above 400% FPL. The enhanced premium tax credits from ARPA and the IRA expired January 1, 2026, so people above $63,840 (single person) or $132,000 (family of four) receive no ACA subsidy in 2026. For Louisiana residents with incomes between 138% and 400% FPL, standard premium tax credits still apply and Marketplace coverage remains affordable. For incomes between 138% and 250% FPL, cost-sharing reductions on Silver plans further reduce out-of-pocket costs. Check your eligibility at healthcare.gov or review the ACA income limits at /aca-income-limits.
