Looking to become a Medicaid Application Center?

Providing services to your community is vital to your facility and it is the goal of the Louisiana Department of Health (LDH). In 1992, LDH began recruiting and approving facilities statewide to become Application Centers for the task of assisting applicants with Medicaid applications. Application Centers make the Medicaid process more accessible to every citizen of Louisiana.

We have been very successful statewide and able to provide Medicaid access to those applicants who may be unable to travel to the local parish office. We are able to reach potential applicants who are homebound, hospitalized or without transportation through agencies in their communities. 

We are streamlining our processes to expedite enrollment at this time.  Please use the links below and complete our contract document package.  We ask that you return the documents by email to ApplicationCenter.Service@LA.Gov and then forward the original contract docs in the mail.  This allows us to schedule your site inspection and training without delay. 

Each person who will be assisting with applications will need to submit an AC-4 (email is sufficient).  The manager will need to complete the form as well and indicate in the upper right hand corner “ACMO”.

The following contractual documents shall only be completed by a company's CEO/CFO:

AC-2 Application Center Contractual Agreement & HIPAA Business Associate Addendum

AC-2a Standard Board Resolution Form

Electronic Funds Transfer (EFT) Enrollment Form

AC-3 Confidentiality Responsibilities / Agreement  

The following documents can be completed by an Application Center Representative and/or Manager:

AC-4 Application Center Request for Representative Training

AC-3 Confidentiality Responsibilities / Agreement