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Understanding Medicare Special Needs Plans

Medicaid is a federally funded health care program, but each state has its own eligibility requirements and types of coverage. The Louisiana Medicaid program operates under the Louisiana Department of Health and is called “Healthy Louisiana.” Health care is confusing, but this guide can help you figure out whether or not you are eligible for Medicaid in Louisiana and answer some of the most common questions about Medicaid Louisiana.

• Louisiana Medicaid Eligibility
• The Louisiana Medicaid Application
• Healthy Louisiana Providers
• What is included in Healthy Louisiana Coverage?
• How to get both Medicare and Medicaid in Louisiana

To meet the Louisiana Medicaid eligibility requirements in 2018, you must be a legal Louisiana resident between the ages of 19 and 64 (unless you are enrolling in the children’s program) with an income of less than 138% of the federal poverty level (according to the graph below).

If you do not meet the Louisiana Medicaid eligibility requirements but your health care costs are extravagant and unaffordable, you might still qualify. If you spend so much money on your health care services that you end up falling below 138% of the federal poverty level, you can still qualify. This is often called the “Spend-Down Program.”

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To complete your Louisiana Medicaid application, you need your social security number or alien identification, any employer and income information for your household, and policy numbers for any other health insurance you have.

When you apply for Medicaid Louisiana online, you’ll create an account. That way you can save and view your entire application history and refer back to find out if your application has been submitted.

You can apply through the online portal or by completing and mailing in this Louisiana Medicaid application. If you need help or would prefer to complete your application over the phone, call 1-800-342-6207.

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Healthy Louisiana has a provider search tool that you can use to search for medical or behavioral health providers in your area and find out who accepts your plan. You can also use the tool to find out if a doctor is accepting new patients, whether the doctor is a man or a woman, any age restrictions, and what languages the doctor speaks.

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All U.S. Medicaid programs are required to cover inpatient and outpatient hospital services, doctor visits, labs and x-rays, long-term care and nursing homes, and family planning. Thankfully, Medicaid Louisiana plans typically provide more than that.

Healthy Louisiana plans vary based on the parish. Each plan offers different additional benefits like diabetic screenings, prescription copays, prenatal and postpartum exams, counseling to help to stop smoking, and even rewards for making healthy choices (like attending wellness visits and getting flu shots). When choosing your Healthy Louisiana coverage, you’ll want to consider not only the benefits but also the network. If you already have a doctor that you like, you should make sure that your doctor accepts your new Healthy Louisiana plan.

LaCHIP is the Louisiana Children’s Health Insurance Program, and the LaCHIP Affordable plan is LaCHIP for kids whose families earn too much to qualify for LaCHIP but who would not otherwise be insured. LaCHIP includes no fees, premiums, copayments, or deductibles!

The program covers doctor visits (preventative and emergency), immunizations, prescriptions, hospitalization, home health care, dental, vision, hearing, medical equipment, some therapy services, and more. Families with young kids who have developmental disabilities have access to additional benefits like assistive technology and family education through the Louisiana Early Steps program.

To qualify for LaCHIP, you must be under 19, not have other insurance, and have a household income below the Medicaid limits according to family size. Kids with disabilities can qualify under the Family Opportunity Act with different income limits. View the graph above for income limits.

*Numbers are subject to change each year.

To apply for or renew your LaCHIP benefits, visit the Louisiana Medicaid Online Services Center or download the Louisiana Medicaid application and mail it in. If you do not have access to a printer, you can also have the application mailed to you or visit a Social Security Office near you. Call 1-877-252-2447 for help.

If you don’t qualify for LaCHIP, you can still apply for the LaCHIP Affordable Plan to see if you qualify. Just download the application and mail or fax it to the LaCHIP Processing Office at P.O. Box 91278, Baton Rouge, LA 70821-9278 (1-877-523-2987).

The LaMOMs program provides no-cost health coverage for prenatal and delivery care to pregnant women. The Take Charge Plus program provides coverage for family planning services including birth control, STI/STD testing and treatment, sterilization, vaccines, and cervical cancer screenings and treatment.

See the income eligibility chart above to find out if you qualify for LaMOMS or Take Charge Plus.

Alternatively, if you are a woman who does not qualify for Medicaid but does not have access to good health insurance and has concerns about breast and cervical cancer, you may qualify for no-cost screenings and treatment. You can apply if you are screened and found to need treatment for breast or cervical cancer. You can start by scheduling a screening at 1-888-599-1073.

Louisiana’s Medicaid Purchase Plan allows those with severe disabilities to go to work but still qualify for Medicaid. To qualify, you must have a Social Security-qualifying disability, be between the ages of 16 and 65, have less than $10,000 in assets, and earn less than $1,012 per month or $1,372 for a household of two.

Depending on your plan, you can get some mental health services covered by Healthy Louisiana. Some examples of covered services are mental illness, substance abuse, addictive disorders, drug and alcohol misuse, and mental disorders like autism.

Magellan of Louisiana is the MCO (managed care organization) for LaCHIP. The MCO has mental health, substance abuse, and therapy providers. Click here to find a Magellan provider near you.

MCNA Louisiana provides dental services for all Medicaid beneficiaries in the state of Louisiana. Covered services for kids (LaCHIP) include both preventative and diagnostic (cleanings, exams, X-rays, sealants, etc.) and therapeutic (cavities, fillings, extractions, root canals, emergencies, etc.). Adults have coverage for exams, x-rays, and dentures. Click here to find an MCNA dentist near you.

Healthy Louisiana works with LogistiCare to help get you to your medical appointments. As a Louisiana Medicaid member, you can get free rides to doctor’s appointments, mental health providers, urgent care offices, pharmacies, and other covered services. To get a ride through Logisticare, you will need your Healthy Louisiana plan member ID number, your address and contact information, your destination’s address and contact information, the date and time of your appointment, whether or not you have a wheelchair or other equipment, and the name of a caregiver or guardian who will be accompanying you (if applicable). Those under the age of 16 must be accompanied by an adult.

Medicaid Louisiana covers most prescription drugs. If you have both Medicare and Medicaid, you will get your prescriptions through your Medicare Part D or prescription drug plan. If you are getting your prescriptions covered through Medicaid (not Medicare), you have coverage for all except cosmetic drugs, cough and cold, anorexics, fertility drugs, experimental drugs, erectile dysfunction, narcotics, and some over the counter drugs. Most people will be responsible for a copay of anywhere from $.50 to $3.00.

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If you are eligible for Medicaid but you are also over the age of 65 or have been diagnosed with ALS or ESRD, you can ALSO get Medicare coverage. When you have both Medicare and Medicaid coverage, you are considered “dual-eligible” and can enroll in a Medicare Advantage dual-eligible special needs plan.

To get more information about saving money on health care by enrolling in Medicare Advantage, set up an appointment with a Medicare benefits advisor in your area or call us at 833-438-3676.

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