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Louisiana Medicaid Eligibility Manual Application Processing
Issued January 7, 2026 Replaced July 16, 2024 Page 13 of G-0000 Revised/added text indicated by underscore Deleted text indicated by “**”
G-940 REQUIRED INTERVIEW EXPLANATIONS The agency requires all initial applications to be signed by the applicant under penalty of perjury.
During the application interview, explain the following in terms that the applicant can understand: The applicant's responsibility to provide information that is true and correct to the best of their knowledge; The applicant's responsibility to cooperate in the eligibility determination process; The applicant's responsibility to report all changes that may affect eligibility; The legal penalties for withholding information or providing false information; That the applicant's SSN will be matched against files of the Social Security Administration (SSA); The agency's confidentiality policy; The agency's nondiscrimination and equal delivery of services policy; The applicant's right to an agency conference or a fair hearing; Assignment of rights to medical support and third party resources, and Estate Recovery. NOTE: The National Voter Registration Act of 1993 (NVRA) requires the Agency to offer the applicant/beneficiary the opportunity to register to vote when applying for benefits, renewing benefits, or changing their address and/or name. During the application interview, the following information must be furnished to all applicants and other individuals who request it: The eligibility requirements; Available Medicaid Services; and