Act 421 Children's Medicaid Option (421-CMO)

Not sure if you qualify? Apply to find out.

IMPORTANT:

• If you do not choose a health plan at this step in the process, a plan is randomly assigned.  Visit Choose a Plan for more information about selecting a plan. 
• When applying online, you must:
  • Place a check in the box next to the applicant that has a disability on the Additional Personal Details screen:
    
    
  • Select which applicant has a disability, and choose Disabled from the drop down box:
    
• When using a paper application to apply, the disability question (as shown in question 12 below) needs to be answered 'yes' to be routed for Act 421-CMO processing:
  

Your Human Services District needs to complete an assessment to determine if the applicant meets the level of care requirement. You will receive a level of care packet, which contains documents to complete and return to LDH. All forms must be filled out completely, supporting documentation provided (where indicated) and returned to LDH timely. Failure to provide this information will result in rejection of your application for the Act 421 program.

Families will receive a packet to complete and return to Medicaid.  The forms that you receive are dependent on which level of care pathway is deemed appropriate for your child. Your packet may contain these documents:

• Act 421-CMO cover letter with instructions on how to complete forms;
• Authorization to Release or Obtain Health Information form (HIPAA) - In some situations, it may be necessary for LDH/LGE to request additional information. If you would like LDH to reach out to providers on your behalf, complete, sign and return this form;
• 90-L Request for Medical Eligibility Determination form (90-L Checklist and 90-L Physician Instructions); or a
• Health Records Request Form.

Submit the completed packet to Medicaid 

• Fax to: 1(225) 389-8019
• Email
• Mail:
  Medicaid Application Office
  6069 I-49 Service Road
  Ste B
  Opelousas, LA 70570
• Online (Instructions here)

The Human Services District completes the assessment by reviewing information and forms provided by the applicant so it is important to follow the instructions in the level of care packet when completing the forms.

Applicants that meet the level of care requirement continue to Step 3 of the enrollment process.

Applicants must meet the definition of disability as set forth by the Social Security Administration. Medicaid will request a disability decision from the Medical Eligibility Determination Team (MEDT) for applicants that do not have a disability determination with the Social Security Administration Office. MEDT may need additional documentation in order to reach a decision on the disability determination.

Applicants that meet the disability requirement continue to Step 4.

Applicants meeting the medical and financial requirements will receive Medicaid coverage through a Medicaid managed care health plan.  When completing a Medicaid application, you can choose a  health plan and a dental plan.  If you have not selected a health plan, enrollment in a health plan is automatic upon enrollment in Medicaid. The family will have 90 days from date of enrollment to change plans when automatic enrollment occurs.