Are you thinking about pursuing Louisiana Medicaid coverage? Before you do, determine if the insurance will cover the services, tests, equipment, prescriptions, and supplies you need. Going in with your eyes open can reduce your chance of being hit with a denial down the line. This article will reveal what LA Medicaid covers and what they typically deny. By the end, you’ll have a good idea of what to expect.
The Main Services LA Medicaid Covers
LA Medicaid is very transparent when it comes to the services they cover. Read on for a rundown of services you can reasonably expect to be paid by the plan if you’re a beneficiary:
General Medicaid-Eligible Services
Medicaid Louisiana pays for common service types, including physician services, hospital costs, and immunizations. In addition to those all-important benefits, you can also get coverage for services like hospice care, home health services, chemotherapy, and more:
- Dentures for adults (waiver and non-waiver)
- Dental and orthodontic services
- Applied behavior analysis services
- Audiological services
- Behavioral health services
- Chemotherapy services
- Chiropractor services
- Durable medical equipment
- EarlySteps
- EPSDT services
- Family planning services
- Hearing aids
- Hemodialysis
- Home health services
- Hospital (emergency, inpatient, and outpatient)
- Hospice
- Vaccinations
- Lab and radiology tests
- Medical transportation
- LT-PCS
- Midwife services
- Nurse practitioner services
- Occupational therapy services
- Optical services
- Pediatric day health care
- PACE program services
- Pharmacy services
- Physical therapy
- Physician and Physician Assistant services
- Prenatal Care
- Psychiatric hospital care
- Speech therapy, language evaluation, and therapy
You also get coverage for services provided in:
- Federally Qualified Health Centers
- Free Standing Birthing Centers
- Nursing facilities
- Rural Health Clinics
- Podiatry
- Rehab Clinic
- STD Clinic
Support Coordination Covered By Medicaid
Support coordination services are centered around helping you get the care and assistance you need to best leverage your LA Medicaid coverage. It’s available when you qualify for one of the following waivers:
- Children’s Choice Waiver
- Community Choices Waiver
- New Opportunities Waiver
- Residential Opportunities Waiver
- Supports Waiver
You also get support coordination if you’re a part of either of the following groups:
- Infants and toddlers
- EPSDT-targeted
The following services come with support coordination as well:
- Therapy services
- Transportation
- Tuberculosis clinics
- X-ray services
Medicaid-Eligible Waiver services
Waiver services associated with the following waivers are also typically covered by Louisiana Medicaid:
- Adult Day Health Care (ADHC)
- Children’s Choice
- Community Choices Waiver
- New Opportunities Waiver
- Residential Options Waiver (ROW)
- Supports Waiver
You can find more information about the above services on this Louisiana Department of Health resource.
Services LA Medicaid Does NOT Cover
It’s clear – Medicaid’s benefits cover a vast number of services. But there are several that they simply don’t cover:
- Prescriptions that aren’t deemed medically necessary.
- Drugs, procedures, devices, or equipment that are experimental or investigational.
- Infertility treatments.
- Provider-preventable conditions
- Cosmetic devices, drugs, equipment or procedures.
- Organ harvesting from yourself to a non-Medicaid member.
- Out-of-state services (unless a special exception applies).
*This isn’t an exclusive list of Medicaid non-covered items.
Get Help As Needed From a Support Coordinator
We urge you to ask a support coordinator if you have any additional questions. They have the resources and capabilities to clarify rules and point you toward the information you need. We hope you found what you were looking for, and we wish you the best with your health now and in the future.
