• Resources
• LDH Resources

LDH Resources

• LaCHIP Outreach Flyer (Lunch Flyer)

  Details:

  April 01, 2025

  • Medicaid

  Application Center Forms, Medicaid Forms, Other Forms, Other Medicaid Forms, Medicaid Flyers Posters, Medicaid Forms Library

  Downloadable Assets:

  LaCHIP Outreach Flyer (Lunch Flyer) LaCHIP Outreach Flyer (Lunch Flyer) - Spanish LaCHIP Outreach Flyer (Lunch Flyer) - Vietnamese

• Voter Registration Application

  Details:

  September 18, 2024

  • Medicaid

  Application Center Forms

  Downloadable Assets:

  Voter Registration Application

• Dental Plan Comparison Chart

  Details:

  May 30, 2024

  • Medicaid

  Application Center Forms, Flyers, Posters

  Downloadable Assets:

  Dental Plan Comparison Chart Dental Plan Comparison Chart - Spanish

• Health Plan Comparison Chart

  Details:

  May 17, 2024

  • Medicaid

  Application Center Forms, Flyers, Posters

  Downloadable Assets:

  Health Plan Comparison Chart Health Plan Comparison Chart - Spanish

• Take Charge Plus Outreach Flyer

  Details:

  March 04, 2024

  • Medicaid

  Application Center Forms, Medicaid Forms, Other Forms, Other Medicaid Forms, Medicaid Flyers Posters, Medicaid Forms Library

  Downloadable Assets:

  Take Charge Plus Outreach Flyer

• Medicaid Programs Flyer

  Details:

  March 01, 2024

  • Medicaid

  Application Center Forms, Medicaid Forms, Other Forms, Other Medicaid Forms, Medicaid Flyers Posters, Medicaid Forms Library

  Downloadable Assets:

  Medicaid Programs Flyer

• BHSF Form 2-HPE - Hospital Presumptive Eligibility Qualified Entity (HPEQE) Application

  Details:

  December 20, 2023

  • Medicaid

  Application Center Forms, HPE Forms, Hospital Presumptive Eligibility Forms, Medicaid Forms Library

  Downloadable Assets:

  BHSF Form 2-HPE - Hospital Presumptive Eligibility Qualified Entity (HPEQE) Application

• Homeless Address Table

  Details:

  October 05, 2023

  • Medicaid

  Application Center Forms

  Downloadable Assets:

  Homeless Address Table

• Contact Information Form

  Details:

  May 02, 2023

  • Medicaid

  Application Center Forms, Medicaid Forms, Other Forms, Other Medicaid Forms, Medicaid Forms Library

  Downloadable Assets:

  Contact Information Form Contact Information Form - Spanish Contact Information Form - Vietnamese

• Medicaid General Application

  Details:

  September 09, 2022

  • Medicaid

  Application Center Forms, Medicaid General Application for Health Coverage, Medicaid Applications, Medicaid Forms Library

  Downloadable Assets:

  Medicaid General Application Medicaid General Application - Spanish Medicaid General Application - Vietnamese Medicaid General Application - Additional Person Medicaid General Application - Additional Person - Spanish Medicaid General Application - Additional Person - Vietnamese Medicaid General Application - Employer Coverage Tool Medicaid General Application - Employer Coverage Tool - Spanish Medicaid General Application - Employer Coverage Tool - Vietnamese Medicaid General Application - Appendix D (Personal Assets)

• Medicare Savings Program Application

  Details:

  March 24, 2022

  • Medicaid

  Application Center Forms, Medicaid Applications, Medicaid Forms Library

  Downloadable Assets:

  Medicare Savings Program Application Medicare Savings Program Application - Spanish Medicare Savings Program Application - Vietnamese

• Medicaid Authorized Representative Form

  Details:

  July 20, 2021

  • Medicaid

  Application Center Forms, Medicaid Forms, Confidentiality Forms, Other Medicaid Forms, LTC Forms, Medicaid Forms Library

  Downloadable Assets:

  Medicaid Authorized Representative Form Medicaid Authorized Representative Form - Spanish Medicaid Authorized Representative Form - Vietnamese Medicaid Authorized Representative Form - Instructions