Official Louisiana State Websites use .la.gov 
Secure .gov websites use HTTPS LDH is moving forward with a plan to distribute food benefits on EBT cards. If the USDA, who administers the SNAP program, is prepared and ready to move money into states’ accounts, we will use federal dollars to fund SNAP recipients’ accounts. If they are not ready, LDH will proceed with our state-funded program to provide food assistance to the elderly, the disabled, and households with children through their existing EBT cards.
Hospital Presumptive Eligibility Library
Forms
- BHSF Form 1-HPE – Assessment Tool for Hospital Presumptive Eligibility (HPE) Only
- BHSF Form 2-HPE – Hospital Presumptive Eligibility Qualified Entity (HPEQE) Application
- BHSF Form 3-HPE – Responsibilities and Agreement (Representative Only)
- BHSF Form 4-HPE – Responsibilities and Agreement (Authorized Agent Only)
- BHSF Form 5-HPE – Qualified Entity Log
- BHSF Form 6-HPE – HPEQE RightFax Transmittal
To be authorized as an HPEQE, your facility must submit the following forms to [email protected]:
- Form 2-HPE (signed by Facility Authorized Agent) and listing all representatives and their contact information;
- Each representative listed on the 2-HPE should complete and sign a Form 3-HPE;
- Form 4-HPE (signed by Facility Authorized Agent); and
- Training certificates for each representative listed on Form 2-HPE
Once all required documents are received you will be sent an email indicating your facility has been approved as an HPEQE.
Resources
- Summary Sheet
- Z-200 Chart (from Medicaid Eligibility Manual)
- HPE Provider Manual
- BHSF Form 1-A – General Application for Health Coverage
Email forms to [email protected] or fax to 225-389-2741 or 877-747-0985.