Eligibility and Enrollment

The new system includes advanced new tools that will enhance customer service, improve efficiency and strengthen the integrity of the Medicaid program. Specifically, this includes:

• Real-time verification – connections to state and federal databases will provide more data for real-time verification of citizenship, income, disability and lawful presence in the United States. Applicants can potentially learn of eligibility determinations within minutes.
• More self-service opportunities for applicants and case management options for enrollees, including being able to report changes in contact information online and request a replacement Medicaid card.
• Consistent enforcement of Medicaid eligibility policy through more automated processes. Starting in January, the new system will automatically terminate coverage for those who fail to respond to requests for information that have been mailed to the enrollee’s primary address. This new automated closure process does not include long-term care recipients.
• Reduced paper work. Streamlined and automated processes, as well as new online services will reduce paperwork and lessen the likelihood of important documentation being lost or misplaced.
• Refocused Priorities for Medicaid Staff. Instead of working through cumbersome manual processes that require entry into several different systems, Medicaid staff will be able to focus on individual client needs and cases.

Medicaid applicants and enrollees. Anyone applying for Medicaid, renewing their Medicaid or wanting to manage their Medicaid eligibility information will use the new system – specifically the new self-service portal which replaces the previous online application.

Medicaid and Louisiana Department of Health staff and Medicaid Application Centers. A new eligibility portal has been created for staff and partners who process applications and work Medicaid cases.

Providers. Approximately 600 hospitals, long term care facilities, support coordination agencies and other community partners that previously used the Facility Notification System (FNS) to submit forms to Medicaid will be required to register with and use a new provider portal.

Louisiana Medicaid has a website with the latest information on the new eligibility and enrollment system. Visit the web site here:  http://ldh.la.gov/index.cfm/page/3497.

Provider – There are training videos available for Provider Portal use. These can be found on the Medicaid Eligibility and Enrollment web site here: http://ldh.la.gov/index.cfm/page/3497

Medicaid applicant or enrollee –There is a training video on the self-service portal on the Medicaid Eligibility and Enrollment web site here: http://ldh.la.gov/index.cfm/page/3497. This video shows you what you can do in the self-service portal.

Applicants and enrollees that need additional assistance can call the Medicaid Customer Service Unit at #1-888-342-6207. They can also visit a regional office or a certified Medicaid Application Center for in-person assistance.

• Apply for Medicaid benefits.
• Renew Medicaid coverage.
• See if their Medicaid has been approved or denied.
• Elect to terminate coverage.
• Link a new enrollee to their account.
• Review their current Medicaid case information.
• Report changes to Medicaid like address, employment or other household characteristics.
• Request a new Medicaid card.

Additional features are expected to be available in 2019.

The online portal is the fastest and most efficient way for Medicaid applicants and enrollees to apply for benefits, renew coverage or manage their accounts. We encourage use of this tool whenever possible.

However, if an applicant or enrollee prefers in-person assistance or paper applications, there are other options.

• Visit a Medicaid Application Center. Find a list online here: http://ldh.la.gov/index.cfm/page/262.
• Visit a Medicaid Eligibility Office. Find a list online here: http://www.ldh.la.gov/index.cfm/directory/category/158.

Call the Medicaid Customer Service Unit, toll free at #1-888-342-6207.

For a period of time (not yet determined) following the system go-live, Medicaid will only process renewals for pregnant women, newborns and the New Adult Group (expansion adults).

When Medicaid begins processing renewals again, Medicaid enrollees will not receive phone calls as part of the renewal process. They will ONLY be notified of their renewal by mail.  This letter will include instructions on how to send proof that the enrollee is still eligible for benefits. This is different from the current process and may require some adjustment for current enrollees. It is very important that enrollees keep their contact information updated so they do not miss this important mail.

Starting in January, if an enrollee fails to respond during the given deadline in the letter, their case will be closed and they will lose coverage. Prior to the new system, termination of coverage was a longer manual process. This step will be automated in the new system.

The new system is designed for more efficient and accurate Medicaid eligibility determinations. However, as workers adjust to a new system and technical issues are addressed, expect some service delays and longer wait times on our toll-free line.

Some Medicaid applications will also take longer to process because states are now required to collect additional information to verify eligibility.

The new system has been thoroughly tested, but there will be some technical and business process issues we may need to fix or refine after it is launched. We have rapid-response teams and processes in place to resolve issues, minimize inconveniences and ensure applicants and enrollees get the services they need as quickly as possible.

The modern system we have implemented includes new automated processes and program integrity measures to ensure that applicants and enrollees are, in fact, eligible. As a result, some people may be denied coverage when they apply and others may lose benefits at renewal because they do not meet eligibility requirements.

• Although this may cause understandable frustration, in most cases, the system will be working exactly as it was designed.
• To minimize surprises, please remember to always make sure that Medicaid has the most current contact information and that the household and income information provided is accurate and complete.

Applicants and enrollees with questions or concerns about their coverage or denials or terminations can call the Medicaid Customer Service Unit and we can review their case.  The number is #1-888-342-6207 (toll-free) or e-mail at [email protected].

Yes. You can still call Medicaid for applicant and enrollee questions or for assistance with the application and renewal process. The toll-free Medicaid number is #1-888-342-6207.

For the most part, the new system does not change provider interaction with Medicaid.

There is one major difference that does require action by some providers. The new system includes a provider portal that replaces the Facility Notification System (FNS).  FNS allows nursing homes, hospitals, support coordination agencies and other community partner representatives to submit forms to Medicaid. This includes requests for long term care, waivers and newborn health assistance.

Any provider previously using FNS will need to register with the new system to continue submitting forms to Medicaid. FNS is no longer available.

For any provider-related issues, please contact [email protected]. If you are working to resolve an issue on behalf of a patient, please contact our Medicaid Customer Service Unit, toll free at #1-888-342-6207 or at [email protected].

Yes! People who apply for or get Louisiana Medicaid can submit documents, such as proof of income, online through the Self-Service Portal (SSP). Use this guide to help upload documents in the SSP.