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Bureau of Health Services Financing (Medicaid)
Contact Us - LTC Applicant NEW

Contact Us - LTC Applicant NEW

Please provide the information below:

Your Name

E-Mail Address

Phone Number

Date of Birth

If you are in a facility, what is the name of the facility?

If you receive waiver services, choose your services below: Adult Day Health Care
Community Choices Waiver
New Opportunity Waiver (NOW)
Children's Choice
Residential Options Waiver (ROW)
Supports Waiver

Who is your waiver provider(s)?

Do you have Long Term Care coverage? Yes
No

What Long Term Care coverage do you have?

Have you applied for Long Term Care coverage? Yes
No
An applicant/enrollee may be eligible for Medicaid services in the LTC program if he/she is a resident of: a Medicaid certified nursing facility (NF); A Medicare certified skilled nursing facility (SNF); or A Medicaid certified ICF/ID facility.

Date application submitted

How was the application submitted?

Please allow 45 days from the date you submitted your application to receive an eligibiliy determination. You can also check the status of your application online at https://sspweb.lameds.ldh.la.gov/selfservice/.

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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