Services for Members 0-21

Louisiana Medicaid offers the following benefits to all Medicaid eligible children and youth who are under the age of 21 and have a medical need for the service.

If your child is under 36 months old, call EarlySteps toll free at 1(866) 327-5978. Need help finding a provider? Click here.

Mental Health Rehabilitation Services

Medicaid members under age 21 are eligible for a range of specialized behavioral health services based on the medical necessity for those services. These services are managed by the Healthy Louisiana Managed Care Organizations, and may be subject to prior authorization. For youth enrolled in the Coordinated System of Care (CSoC) waiver program, services are managed by the CSoC Contractor, any may be subject to prior authorization. Covered services include psychotherapy and other services provided by a licensed mental health practitioner, community-based psychiatric support and treatment (CPST), psychosocial rehabilitation (PSR), crisis intervention, and crisis stabilization. Covered substance use disorder treatment services include outpatient substance use treatment services, substance use disorder treatment residential care, and inpatient substance use disorder treatment.

Children and youth at risk of out of home placement may be eligible for the Coordinated System of Care (CSoC) program, in which a Wraparound Facilitator can assist youth and family to coordinate standard Medicaid-covered services, as well as specialized-CSoC services, and natural supports.

Medicaid also covers a range of residential and hospital-based behavioral health treatment services for children and youth who medically need them, including Therapeutic Group Home care, Psychiatric Residential Treatment Facility care, and inpatient psychiatric hospitalization.

Psychological and Behavioral Services

Children and youth who require psychological and/or behavioral services may receive these services from a licensed psychologist. These services include necessary assessments and evaluations, individual therapy, and family therapy.

Early and Periodic Screening, Diagnostic and Treatment Personal Care Services

Personal Care Services (PCS) are defined as tasks that are medically necessary when physical or cognitive limitations due to illness or injury necessitate assistance with eating, toileting, bathing, bed mobility, transferring, dressing, locomotion, personal hygiene, and bladder or bowel movements. PCS does not include medical tasks such as medication administration, tracheostomy care, feeding tubes or catheters. The Medicaid Home Health program or Extended Home Health program covers those medical services. PCS must be ordered by a practitioner. The PCS service provider must request approval for the service from Medicaid or the beneficiary’s health plan.

Extended Nursing Services

Children and youth may be eligible to receive Extended Nursing Services in the home. These services are provided by a Home Health Agency. A physician must order this service. Once ordered by a physician, the home health agency must request approval for the service from Medicaid.

Physical Therapy, Occupational Therapy, Speech Therapy, Audiology Services, and Psychological Evaluation and Treatment

If a child or youth needs services such as Physical, Occupational, or Speech Therapy, Audiology Services, or Psychological Evaluation and Treatment; these services can be provided at school, in an early intervention center, in an outpatient facility, in a rehabilitation center, at home, or in a combination of settings, depending on the child's needs. For Medicaid to cover these services at school (ages 3 to 21), or early intervention centers and EarlySteps (ages 0 to 3), they must be part of the IEP or IFSP. For Medicaid to cover the services through an outpatient facility, rehabilitation center, or home health, they must be ordered by a physician and be prior-authorized by Medicaid.

Durable Medical Equipment (DME) and Supplies

Children and youth can obtain any medically necessary medical supplies, equipment and appliances needed to correct, or improve physical or mental conditions. Medical Equipment and Supplies must be ordered by a physician. Once ordered by a physician, the supplier of the equipment or supplies may request approval for them from Medicaid or the beneficiary’s health plan.

Transportation

Non-Emergency Medical Transportation (NEMT) is transportation provided to Medicaid enrollees to and from a Medicaid provider for a Medicaid covered service when no other means of transportation are available. Scheduling for NEMT should be made at least 48 hours in advance.

Disabled Children's Medical Equipment and Services for the Home

Personal Care Services (PCS)

Personal care services are provided by a trained attendant, when disability, illness or injury causes a child to require assistance with eating, bathing, dressing and personal hygiene.

PCS does not include medical tasks, such as giving medication, tube feeding, or care of an indwelling catheter or tracheotomy.

PCS is not a substitute for child care.

Extended Home Health

This is a medically necessary home nursing care for persons that need more than Personal Care Services skills. Home Health agencies can also provide physical, occupational and speech therapy in the home if this is medically necessary. Home Health Services for children and youth are not limited by frequency or duration.

A physician must order this service, and Extended Home Health Services must also be prior authorized.

Medical Equipment and Supplies

Children are entitled to any medically necessary medical supplies, equipment and appliances needed to correct, improve or assist in dealing with physical or mental conditions.

This includes lifts and other devices to help the family deal with a child's circumstances, and also some medically necessary dietary nutritional assistance.

Medical Equipment and Supplies must be prescribed by a physician and prior authorized.

If you are unable to locate a Home Health provider of Extended Care Services or a Personal Care Services (PCS) provider, or if you have an authorization for services but are not receiving them, contact your support coordinator or call 1-888-342-6207.

Children and Youth with Developmental Disabilities

To request services, call the Office for Citizens with Developmental Disabilities (OCDD) in your area.

DD Medicaid Waiver Services

The following services are available to children and youth with developmental disabilities. To request them call the Office for Citizens with Developmental Disabilities (OCDD) District and Authority in your area. Phone numbers are listed on the attachment.

To sign up for "waiver programs" that offer Medicaid and additional services to eligible persons (including those whose income may be too high for other Medicaid), ask to be added to the Developmental Disabilities Request for Services Registry (DD RFSR) for people with developmental disabilities.

The New Opportunities Waiver (NOW) and the Children’s Choice Waiver both provide services in the home, instead of in an institution, to persons who have intellectual disabilities and/or other developmental disabilities. Both waivers cover family support, center-based respite, environmental accessibility modifications, and specialized medical equipment and supplies. In addition, NOW covers services to help individuals live alone in the community or to assist with employment, and professional and nursing services beyond those that Medicaid usually covers.
The Children’s Choice Waiver also includes family training. Children remain eligible for the Children’s Choice Waiver until their twentieth birthday, at which time they are moved to an age-appropriate waiver for people with developmental disabilities.
The Supports Waiver provides specific, activity focused services rather than continuous custodial care. This waiver offers supported employment, day habilitation, prevocational services, respite, habilitation, permanent supportive housing stabilization, permanent supportive housing stabilization transition, and personal emergency response systems.
The Residential Options Waiver (ROW) is only appropriate for those individuals whose health and welfare can be assured by the support plan with a cost limit based on their level of support need. This waiver offers community living supports, companion care, host home, shared living, one-time transitional services, environmental modifications, assistive technology/specialized medical equipment, personal emergency response systems, respite (center-based), nursing, dental, professional (dietary, speech therapy, occupational therapy, physical therapy, social work, psychology), transportation-community access, supported employment, prevocational services, day habilitation, housing stabilization and housing stabilization transition services.

If you need services for someone 0 to 3 years old, please contact EarlySteps by calling 1(866) 327-5978.

Support Coordination

A support coordinator works with you to develop a comprehensive list of all needed services (such as medical care, therapies, personal care services, equipment, social services, and educational services) then assists you in obtaining them. If you are a Medicaid recipient and under the age of 21 and it is medically necessary, you may be eligible to receive support coordination services immediately by calling SRI (toll free) at 1(800) 364-7828.

If you need a service that is not listed above or need help finding a provider, call the Medicaid Specialty Care Help Desk at (toll free) 1(888) 758-2220.