Medicaid Health Coverage

Once a person is determined to be eligible for Louisiana Medicaid, they will be enrolled in a managed care plan. This means that the person will be assigned to a specific healthcare provider network, which will be responsible for coordinating their healthcare services. The managed care plan will provide the person with a list of healthcare providers in their network, and the person can choose a provider from that list.

To be eligible for Medicaid in Louisiana, you must be a resident of Louisiana and either a 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.

Cost-sharing, premiums, and out-of-pocket costs associated with Medicaid vary depending on the individual's income level. In general, Medicaid programs aim to minimize financial burdens on beneficiaries by limiting cost-sharing requirements and providing coverage for many healthcare services. 

Cost-Sharing: Cost-sharing refers to the portion of the cost of medical care that the patient is responsible for paying. In Medicaid, cost-sharing can include copayments, coinsurance, and deductibles. The amount of cost-sharing varies depending on the individual's income level and the type of service provided. Some Medicaid programs may exempt certain groups, such as children or pregnant women, from cost-sharing requirements.

Premiums: A premium is the amount of money that an individual or family pays for healthcare coverage. In most cases, Medicaid does not require individuals to pay a monthly premium. However, some states may have a limited income program, where Medicaid beneficiaries with higher incomes are required to pay a monthly premium to receive coverage.

Out-of-Pocket Costs: Out-of-pocket costs are expenses that the patient pays for healthcare services that are not covered by Medicaid. These costs can include things like transportation to medical appointments, over-the-counter medications, or dental services. Medicaid programs can provide limited coverage for some out-of-pocket costs, but it varies depending on the state and program.

The first step to apply for Medicaid in Louisiana is to determine your eligibility. 

The determination of eligibility for Medicaid is based on the income guidelines established by the Federal Poverty Levels. Your income must fall below a certain level according to the monthly income limits for Medicaid programs. 

In Louisiana, you qualify to receive Medicaid if you:

• Receive Supplemental Security Income (SSI) from the Social Security Administration (SSA)
• Get financial help from the Office of Family Support (OFS) through the Family Independence Temporary Assistance Program (FITAP)

You may also qualify for Medicaid coverage if you:

• Are disabled according to the Social Security Administration’s definition
• Have corrected vision no better than 20/200
• Are a low-income parent of children under age 19
• Are a child under age 19
• Are pregnant
• Have no insurance and need treatment for breast and/or cervical cancer
• Receive Medicare coverage and are low-income, or 
• Are aged 19 to 64 years old, have a household income less than 138% of the federal poverty level, doesn't already qualify for Medicaid or Medicare, and meet citizenship requirement

You will need to gather documents that prove your identity, income, and other information such as your Social Security number, proof of citizenship or immigration status, and recent pay stubs. Each application will tell you what information you need to send in with your application form. 

You can apply for Medicaid online by visiting the Louisiana Medicaid Self-Service Portal (SSP). 

You can also apply by mail, by phone, or in person. 

• Call the Medicaid hotline toll-free at 1.888.342.6207 for help applying. Agents are accepting calls Monday through Friday from 8 a.m. to 4:30 p.m.
• Contact any Medicaid Application Center statewide.
• Download and print a Medicaid application and then mail or fax it to Medicaid as directed on the form.
• Contact your local Medicaid office for help applying.

After you submit your application, you will get a notice from the Medicaid agency letting you know if you are eligible for coverage. 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 Health Louisiana plan ID card, if you enroll in a plan. 

If you are eligible for Medicaid, you will need to choose a health plan from the options available. Healthy Louisiana is the way most of Louisiana's Medicaid recipients get health care services. As soon as you or your 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 plan, Healthy Louisiana will choose one for you or your family. Compare health plans to find the best plan for you.

Once you are enrolled in Medicaid, you can begin using your benefits to access healthcare services. 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. 

You have the right to appeal any 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.

One factor that can impact Medicaid eligibility is child support obligations. Child support payments made by a noncustodial parent are not considered income for Medicaid purposes. However, any child support payments received by the custodial parent are counted as income and may affect Medicaid eligibility. 

In addition, if a parent fails to comply with a court-ordered child support obligation, their Medicaid benefits may be reduced or terminated. 

You can be eligible for both Medicaid and Medicare. This is known as "dual eligibility." Dual eligibility is common among older adults and individuals with disabilities. 

Learn more about Medicare by visiting this resource here.