Healthy Louisiana

Healthy Louisiana is the way most of Louisiana's Medicaid and LaCHIP recipients receive health care services. The state contracts with Health Plans that deliver these services through their provider networks. Recipients are given the chance to choose the Health Plan that best fits their family's needs.

Most, but not all Medicaid/LaCHIP recipients are enrolled with a Managed Care Plan. Nearly 1.1 million of Louisiana's current 1.4 million recipients are enrolled in a Health Plan for some part of their health care. Some recipients have the option to enroll in a Health Plan or remain in the regular Medicaid program, while some recipients are excluded from Health Plan enrollment.

The populations that are excluded from participation in the Managed Care Plans and who will receive all their services in the regular Medicaid program are

• Recipients over age 21 who are residents of an intermediate care facility for the developmentally disabled (ICFDD).
• Recipients with limited eligibility periods of 3 months or less (Spend-down Medically Needy)
• Recipients receiving a limited benefit package (for example the Medicare Savings Plan)

Some recipients only receive specialized behavioral health, non-emergency medical transportation or non-emergency ambulance transportation through their Health Plan. Recipients who are part of the Coordinated System of Care (CSoC) receive all covered services except specialized behavioral health and CSoC services through their Healthy Louisiana Plan. See below for more detail on who receives what type of services through Healthy Louisiana:

1. Coverage for all Medicaid Covered Services - Most Healthy Louisiana recipients are in this category and get all their Medicaid covered services though their Health Plan. Services include acute care (these include short-term treatment for a severe injury or an episode of an illness or an urgent medical condition) and behavioral health care (mental health and substance use treatment).
2. Coverage for Specialized Behavioral Health and Non-Emergency Ambulance Transportation - Individuals in a nursing facility or those under the age of 21 residing in an intermediate care facility for the developmentally disabled (ICFDD) receive this type of coverage. Their acute care services and any non-emergency medical transportation other than non-emergency ambulance transportation is handled through the facility.
3. Coverage for Specialized Behavioral Health and Non-Emergency Medical Transportation (NEMT) including Non-Emergency Ambulance Transportation - Individuals with both Medicaid and Medicare receive this coverage, unless they are in a nursing facility or an ICFDD.
4. Coverage for all Covered Services except Specialized Behavioral Health and Coordinated System of Care (CSoC) Services - This applies to the CSoC population, who will still get their specialized behavioral health through Magellan.
5. Individuals who have Medicaid waivers for Intellectual or developmental disabilities or children with Medicaid who are on the waiting list for a waiver may choose to have all of the health care through the Health Plan or only their specialized behavioral health services. This is called "OPT-IN". They may choose to disenroll their health care from their Health Plan and go back to regular Medicaid at any time. The disenrollment will be effective the first day of the following month, unless the request is made during the last two days of the month. Then, the disenrollment will be effective the first day of the month after the following month.

Medicaid applicants can now select a Plan when applying for Medicaid (on the application).

If Medicaid/LaCHIP recipients do not select a Plan and are mandated to participate in Healthy Louisiana, they will be automatically assigned to a Plan.

Healthy Louisiana uses a process that considers prior member choice and family and provider relationships when selecting a Plan for a member that did not make an active choice. The full process is shown in Informational Bulletin 12-16.

Federal requirements allow recipients to change Health Plans (at will) during the first 90 days of their enrollment. After the 90-day period ends, recipients will remain in their chosen Health Plan until the next annual open enrollment period. Recipients will be allowed to change Health Plans for cause outside of the open-enrollment period.

However, children with Medicaid who are also on the waiting list for a developmental disability waiver (Chisholm class recipients), and individuals with intellectual or developmental disabilities who have a Medicaid Home and Community based waiver, who are Voluntary Opt-In, can initially enroll in Managed Care at any time. They may disenroll from Managed Care at any time. The disenrollment will be effective the first day of the following month, unless the request is made during the last two days of the month. Then, the disenrollment will be effective the first day of the month after the following month.

Recipients in Healthy Louisiana have two cards. One is the standard Louisiana Medicaid card. This card can be used by providers to verify eligibility and the patient's current Health Plan. The second card is a Health Plan card - providers can use information on this card to contact the Health Plan with questions and problems.

Healthy Louisiana mails out welcome packets during the open enrollment period or whenever someone is newly enrolled in Healthy Louisiana. This packet includes a confirmation letter and a Health Plan comparison chart, along with all the details about how to change plans. No action is needed if you do not want to change your Health Plan.

This is a question only you can answer. You need to look at what is best for you and your family.

• Make a list of all your doctors, important prescriptions, any other health professional services you receive such as occupational therapy, physical therapy, speech therapy, etc. Find out which Health Plans your providers will accept and which Plans cover the medications you receive.
• If you have Healthy Louisiana coverage for all Medicaid covered services, use the comparison chart of all the Healthy Louisiana Plans found at www.healthy.la.gov. This will show you what "extra benefits" those Health Plans offer. Health Plan extra benefits are only available if you have both your health care and specialized behavioral health services with a Healthy Louisiana Plan.

No, the Health Plans must provide the same services that the regular Medicaid Program covers and in the same "amount, duration, and, scope." The Plans can add benefits, but they cannot reduce them. Also, the Plans cannot charge co-pays unless regular Medicaid has a co-pay.

Yes. Recipients should check with their providers to be sure they accept both their private insurance and their Health Plan.

The Healthy Louisiana Plans are required to have all specialties in their provider network.

You can only see doctors in your Health Plan's network. Check with your Health Plan's member services department before seeing an out-of-network doctor.

Each individual recipient can have a different plan.

It depends on the Health Plan's policy. Check with your Health Plan first.

Yes, the recipient can go to any ER. The Health Plan must cover and pay for emergency services regardless of whether the provider that furnishes the emergency services has a contract with the Health Plan. If an emergency medical condition exists, the Health Plan is obligated to pay for the emergency service.

Recipients enrolled in a Health Plan for their specialized behavioral health services ONLY will get all of their pharmacy benefits through regular Medicaid. Recipients enrolled in a Health Plan for all of their health care services will receive all their pharmacy benefits through the Health Plan.