Medicaid

What Is Medicaid?

The Medicaid program provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered and operated by the Louisiana Department of Health, according to federal laws and regulations. The federal government works with the state Medicaid agency to make sure they comply with federal laws and regulations. The Medicaid program is funded by the state and the federal government.

Who can tell me if I have Medicaid health coverage?

If you are not sure if you have Medicaid health coverage, call Medicaid Customer Service toll free at 1-888-342-6207. You can apply for Medicaid at any time. Medicaid Customer Service can help you apply by phone.

What if I am not a U. S. citizen?

To be eligible for Medicaid in Louisiana, you must be resident of Louisiana and either U.S. citizen or a non-citizen who is lawfully present in the U.S. Non-citizens (residing legally or illegally) can qualify for coverage for emergencies and labor and delivery services if income requirements are met. Medicaid and LaCHIP coverage may be available to children up to age 19 who are lawfully residing and are otherwise eligible.

How do I apply for Medicaid?

You can apply for Medicaid at any time.

  1. Apply online by visiting the Medicaid Self-Service Portal.
  2. Download and print an application. Then mail or fax all pages to Medicaid as directed on the form.
  3. Call Medicaid Customer Service toll free at 1-888-342-6207 to apply by phone.
  4. Apply in-person at your local Medicaid office.
  5. Contact any Medicaid Application Center statewide.        

Even if you applied by mail, in-person, or over the phone, you can create an online account to check the status of your application, report household and address changes, request a new Medicaid ID card, and renew your Medicaid coverage.

What information do I need to send in with my Medicaid application form?

Each application will tell you what information you need to send in with your application form. We will review your application and information when we receive it. We will let you know if we will need any other information to decide if you qualify for Medicaid benefits.

How does Medicaid work?

The Medicaid program does not provide health care services for everyone. Your application will be reviewed for all Medicaid programs. If you are found eligible for Medicaid, you will get:

  • A letter in the mail from Medicaid telling you about your coverage
  • A Medicaid ID card
  • A Healthy Louisiana plan ID card, if you enroll in a plan.

Each time you go to your health care provider or pharmacy, take your Medicaid ID and Healthy LA plan ID cards with you. Show them at all medical visits before you receive any service. The health care provider or pharmacy will tell you if they accept your Medicaid benefits. You should also ask your health care provider or pharmacy if the service or prescription is covered by Medicaid before receiving the service or filling a prescription.

Medicaid does not pay money to you; instead, it sends payments directly to your health care provider or pharmacy.

What is Healthy Louisiana?

Healthy Louisiana is the way most of Louisiana's Medicaid recipients receive health care services. As soon as you or family members are eligible for Medicaid, you need to choose a Healthy Louisiana Health Plan to manage your or your family member’s health care. If you do not choose a health plan, Healthy Louisiana will choose one for you or your family.  Compare health plans to find the best plan for you.  If you have questions, call Healthy Louisiana at 1-855-229-6848 (TTY: 1-855-526-3346).

What if I have questions about my Healthy Louisiana Plan?

If you have questions about your Healthy Louisiana plan, contact your plan’s customer service department.

 

  • Aetna Better Health 1-855-242-0802 TTY: 711  Available 24 hours a day, 7 days a week
  • Healthy Blue 1-844-521-6941 Available Monday – Friday, 7:00 a.m. - 7:00 p.m.
  • AmeriHealth Caritas 1-888-756-0004 Available 24 hours a day, 7 days a week.
  • Louisiana Healthcare Connections 1-866-595-8133 Available Monday – Friday, 7:00 a.m. - 7:00 p.m.
  • UnitedHealthcare Community 1-866-675-1607 Available Monday – Friday, 7:00 a.m. – 7:00 p.m

What services does Medicaid cover?

All Healthy Louisiana plans offer the same basic benefits.

 

  • Behavioral health services
  • Chronic illness management
  • Dental services
  • Durable medical equipment, prosthetics, orthotics and certain supplies
  • Early periodic screening, diagnostic, and treatment (EPSDT)/well-child visits
  • Emergency and non-emergency medical transportation
  • Emergency medical services
  • Family planning services
  • Immunizations/vaccines
  • Inpatient/outpatient hospital services
  • Laboratory tests and x-rays
  • Pregnancy and newborn care
  • Prescription medicines/pharmacy
  • Rural health clinic services
  • Unlimited primary care physician visits
  • Vision services
  • Women’s health services
  • And many more benefits

 

Compare health plans to see the extra services that each plan offers.

How do I replace my Medicaid ID card?

Call Medicaid Customer Service at 1-888-342-6702 to request a new card or visit the online Medicaid Self-Service Portal. You can create an online account at any time.  Until you receive your new card you should call your health care provider before your appointment to make sure they can verify your coverage.

 

If you need a new Healthy Louisiana plan ID card, call the member services department for a replacement card.

How can I find a doctor that accepts Medicaid?

For Healthy Louisiana plan members, contact the member services department with questions about how to access care.

 

For Louisiana MCNA dental plan members, visit MCNA Dental Online Provider Directory or call the member hotline at 1-855-792-6262 Monday – Friday from 7 a.am. to 7 p.m. to find a dentist in your area.

 

For Legacy Medicaid members, call 1-877-455-9955 to find a specialist in your area.

 

It is important to remember that not all doctors who are active in the Medicaid program are taking new patients. When you call for an appointment, be sure to ask if the doctor is taking new Medicaid patients.

How do I report an address change?

Call Medicaid Customer Service toll free at 1-888-342-6207 or go online by visiting the Medicaid Self-Service Portal to update your address.

 

If you do not have an online account, you can create an account at any time.  Creating an online account allows you to check the status of your application, report any household changes, report an address change, request a replacement Medicaid ID card, and renew your Medicaid benefits.

How does the Medically Needy Spend-Down Program work?

Medically Needy provides Medicaid eligibility to qualified individuals and families who may have too much income to qualify for regular Medicaid programs.  Individuals and families who meet all Medicaid program requirements, except that their income is above those program limits, can spend-down or reduce their income to Medicaid eligibility levels using incurred medical expenses.

What if I think a decision you make is unfair, incorrect, or made too late?

You have the right to appeal the Medicaid decision. There are several ways to request an appeal. You can write the reason you disagree with the decision on the back of the decision letter and then mail or fax it to Medicaid as directed on the letter. You can also fax the decision letter to the Division of Administrative Law at 225-219-9823 or mail it to the Division of Administrative Law, Department of Health Section, P. O. Box 4189, Baton Rouge, LA 70821-4183. You can request an appeal by phone by calling Medicaid Customer Service at 1-888-342-6207 or the Division of Administrative Law at 225-342-5800.

Will Medicaid provide payment for a family member who needs nursing home care?

Louisiana's Medicaid Program provides payment for special long term care support services, as well as full Medicaid health coverage, to eligible people who, because of their medical condition, require assistance with activities of daily living (for example, eating, bathing, dressing, grooming, and transferring).  Long-term care supports may be provided either in a facility or in an individual's own home or in the community.  Visit Medicaid Long-Term Care

Where can I find information about a nursing home's health or fire-safety inspection results?

Health and fire-safety inspections with detailed and summary information about deficiencies found during the three most recent comprehensive inspections (conducted annually) and the last three years of complaint investigations are found on the Medicare.gov Nursing Home Compare website.

 

Nursing Home Compare allows consumers to search for a nursing home based on location and compare the quality of care they provide and their staffing. Nursing Home Compare has detailed information about every Medicare and Medicaid-certified nursing home in the country.

 

For information about Louisiana nursing homes or any other nursing home inquiry, contact the LDH Health Standards Section, Nursing Home Program Desk at 225-342-0114 or visit the Louisiana Nursing Home Association website. Nursing home providers are required to post the results of their most recent inspection in the facility.

How can I report Medicaid Fraud?

If you suspect a person or a doctor, clinic, hospital, home health service or any other kind of medical provider is committing Medicaid fraud or abuse, report it.

 

  1. Call toll-free 1.800.488.2917 or 1-877-455-9955 for Provider Fraud complaints.
  2. Call toll-free 1.888.342.6207 for Recipient Fraud complaints.
  3. Visit Louisiana Medicaid Fraud for more information
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