Louisiana Medicaid Application Center Resource Library

 

IMPORTANT: This webinar was regarding your Application Center data and our new computer system. We need someone with knowledge of all aspects of the Application Center, including payment details and satellite locations (probably the AC Manager) to complete the spreadsheet. The deadline for submitting this information is January 31, 2018

 

Use your computer to complete the spreadsheet; handwritten spreadsheets will not be accepted.


If you do not submit the spreadsheet with your facility information by January 31, 2018, you will have to wait to sign up using the new system on July 30, 2018. Please ensure that your facility can continue to take Medicaid applications when we go live by turning in your data by January 31, 2018.

 

Click here to view a recording of the webinar: https://register.gotowebinar.com/register/5711072689716096769

 

Application Center Data Conversion Spreadsheets

EXAMPLE WORKBOOK - General Hospital

LaMEDS AC Registration Workbook

 

Application Center Websites

AC Demo Changes/Replacement Cards  
App Center Online Training  
Online Application  

 

Application Center Documents

Application Center Handbook

 

AC-2 and addendum (Application Center Contractual Agreement & HIPAA Business Associate Addendum)

Instructions

AC-2a (Standard Board Resolution Form)

Instructions

AC-3 (Confidentiality Responsibilities / Agreement)

Instructions

AC-4 (Application Center Request for Representative Training)

Instructions

AC-5 (Log of Referrals) Instructions

AC-7 (RightFAX Cover and Transmittal Log)

Instructions

AC-8 (Inspection / Monitoring Report)

Instructions

AC-8a (Monitoring Corrective Action Results)

Instructions

AC Signage Template

 

AR (Consent for Authorized Representation)

Instructions

Clearance (Statement of Applicant)

Instructions

Electronic Funds Transfer (EFT) Enrollment Form  

General Application

 
General Application - Additional Persons  
General Application - Employer Coverage Tool  
General Application - Appendix D - Personal Assets  
General Application - Spanish  
General Application - Vietnamese  
Health Plan Non-Timely Filing Procedures  
Healthy LA Comparison Chart - Printout  
Healthy LA Comparison Chart - Web Viewing  
HIPAA 202L (Authorization to Release Health Information)  

HIPAA 402P (Authorization to Release or Obtain Health Information)

Instructions

Ins-LR (Request for Life Insurance Policy Information)

Instructions

MS (Social Information Interview)

Instructions

Medicare Savings Program Application (1-MB)

 

MS/C (Child's Medical & Social Interview)

Instructions

Resources (Request for Resources & Interest Income Information)

Instructions

Verification (Application Verification Request Form)

Instructions

Voter Registration Application (LR-1 & 1M)

 

Voter Registration Declaration (English)

 

Voter Registration Declaration (Spanish)

 
Voter Registration Declaration (Vietnamese)  


Voter Registration Poster (English)

 

Voter Registration Poster (Spanish)

 

Voter Registration Poster (Vietnamese)

 

Wages (Personal Wage Record)

 Instructions
WIC 38 Flyer  

 

CONTACT INFORMATION

Josie McElroy

ApplicationCenter.Service@la.gov

Fax: (225) 376-4736