Based on concerns of future state obligations, Louisiana has opted not to fund the optional expansion of Transitional Medical Assistance and utilization of the temporary increase in the state's DSH allotment.

ARRA provides for a mandatory extension of the TMA program beyond the current expiration date of June 30, 2009, to December 31, 2010. It also provides states with a new option of expanding the coverage period from 12 months to 18 months and providing TMA for individuals leaving welfare for work who received benefits for fewer than three months. While the state must provide the mandatory extension it chose not to fund the optional extension and expansion.

The state has also turned down the temporary increase in state DSH allotments as it would require additional state expenditures in order to draw the additional match. The state retains the option to utilize the additional allocation should matching funds become available, but does not want to depend on temporary, and therefore unreliable, funding that could create obligations for the state down the road.