Louisiana Medicaid Application Center Resource Library

 

CONTACT INFORMATION

Josie McElroy

ApplicationCenter.Service@la.gov

Fax: (225) 376-4736

At this time we are receiving a large number of repeated requests, we will call you when we get an opportunity to look at your case specifically.

 

Application Centers may view the Medicaid Eligibility System Webinar recording from the following link: 

https://register.gotowebinar.com/recording/8658288326013667083. Or you may follow the instructions here.

 

We are pleased to announce that the new Medicaid Self-Service Portal is available Tuesday, November 13 at 6:30 a.m.

Getting Started 

Link to the new SSP: https://sspweb.lameds.ldh.la.gov/selfservice/

Application Center Representatives will click the Partner tab to begin.

Need Assistance?

Office hours will be available from 10 a.m. to 11 a.m. daily starting November 13 until November 20. During this time, Application Center Representatives may dial into the webinar and/or conference line below with questions and to receive system help.

Conference line: 866-434-5269

Access Code: 7954246#

Registration URL: https://attendee.gotowebinar.com/register/6085618034085689602

Webinar ID: 773-971-499

 

Application Center Websites

App Center Online Training  

 

Application Center Documents

Application Center Evaluation  
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

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