Page 1

Louisiana Medicaid Eligibility Manual Medical Services Reissued August 20, 2024 Replacing May 30, 2023

Page 1 of C-0000 Revised/added text indicated by underscore

Deleted text indicated by “**” C-0000 MEDICAL SERVICES

The following is a brief overview of medical services covered by Medicaid. Refer questions regarding specific medical services to the appropriate medical provider. Medical providers have access to Provider Manuals, the fiscal intermediary, and appropriate personnel within BHSF.

Managed care organizations are the way most of Louisiana’s Medicaid and LaCHIP beneficiaries receive health care services. Medicaid included populations are enrolled into a Healthy Louisiana plan. These plans all offer the same basic benefits but can differ by provider networks, referral policies, health management programs, extra services, and incentives. These plans are accountable to the Louisiana Department of Health (LDH).

C-100 GENERAL INFORMATION

Beneficiaries receive a Medical Eligibility Card (MEC) and are entitled to the services listed below, if the health services provider:

• is enrolled in the Medicaid Program, and

• agrees to bill Medicaid for services to the eligible person listed on the MEC.

Beneficiaries shall present the MEC when health care is requested.

Providers who accept Medicaid payment cannot bill beneficiaries.

Exceptions:

Medically Needy Spend-Down beneficiaries may be billed for partial payment of a medical bill on the Spend-Down date.

Long Term Care beneficiaries may be billed for a portion of the monthly facility fee.

Beneficiaries covered by third parties legally responsible for paying medical claims. Refer to P-0000, Third Party Liability.