Louisiana Medicaid, run as Healthy Louisiana, covers doctor visits, hospital stays, emergency care, prescription drugs, behavioral health and addiction treatment, maternity and postpartum care, long-term care at home or in a facility, non-emergency medical transportation, and durable medical equipment. Children under 21 also get full dental, vision, hearing, and therapy services. Adult dental is limited mostly to extractions and dentures, and routine adult vision isn’t covered at all. What Medicaid covers in Louisiana depends partly on your age and partly on which program you qualify under, so the details below are organized by the type of care you’re looking for.
Doctor Visits, Hospitals, and Emergency Care
Visits to primary care doctors, specialists, nurse practitioners, nurse midwives, physician assistants, and clinical nurse specialists are covered.1Louisiana Department of Health. Medicaid Services Chart You generally don’t need a referral to see a specialist under Healthy Louisiana, though your managed care plan may have its own network rules.
Inpatient and outpatient hospital care is covered, including surgery and rehabilitation. Emergency room visits are covered regardless of whether the hospital is in your plan’s network, because federal law requires it. Lab tests and radiology ordered by your doctor are covered as well.1Louisiana Department of Health. Medicaid Services Chart
Telehealth is covered on the same terms as in-person care when the service would otherwise be covered in person, and there’s no restriction on where you connect from, including your home.2Louisiana Department of Health. Informational Bulletin 25-28 – Telemedicine Behavioral health appointments can be done by telehealth too.
Prescription Drugs
Medications on the state’s preferred drug list are covered, including both generics and brand names across every covered therapeutic class.3Louisiana State Legislature. Louisiana Code RS 46:153.3 – Medical Vendor Reimbursements A drug that isn’t on the list may still be covered, but your prescriber’s office will need to request prior authorization from your health plan.
Most adults pay a small copay per prescription, tied to what the drug costs:
- $0.50 for drugs costing $10 or less
- $1.00 for drugs costing $10.01 to $25
- $2.00 for drugs costing $25.01 to $50
- $3.00 for drugs costing more than $50
Several groups pay nothing: children under 21, pregnant women, people in nursing facilities, hospice patients, home and community-based waiver recipients, and Native Americans.4Louisiana Department of Health. Pharmacy Copayment Schedule Emergency medications and preventive drugs recommended by the U.S. Preventive Services Task Force are also exempt from copays.
Preventive Care and Screenings
Preventive services are covered at no cost. For adults, that includes immunizations, blood pressure and cholesterol screenings, diabetes screening for people 40 to 70 who are overweight, colorectal cancer screening starting at age 45, depression screening, HIV screening, hepatitis B and C screening, lung cancer screening for high-risk adults 50 to 80, tobacco cessation counseling, and obesity screening.5HealthCare.gov. Preventive Care Benefits for Adults Children get periodic screenings and immunizations through the broader children’s benefit described below.
Behavioral Health and Substance Use Treatment
Adults get outpatient therapy with licensed practitioners, medication management, individual and group counseling, and addiction treatment at the outpatient, residential, and inpatient levels. Psychiatric inpatient care is covered for adults ages 18 to 21 and over 65.6Louisiana Department of Health. Medicaid Services
For opioid use disorder specifically, Louisiana covers medication-assisted treatment using naltrexone, buprenorphine, and methadone in all FDA-approved forms, together with counseling and behavioral therapy.7Centers for Medicare & Medicaid Services. Louisiana State Plan Amendment 21-0002
Children’s behavioral health coverage is broader. It includes psychiatric inpatient hospital care without the adult age limits, along with applied behavioral analysis and mental health rehabilitation services.8Louisiana Department of Health. Services Available to Medicaid-Eligible Children Under 21
Pregnancy, Postpartum, and Family Planning
Pregnant women enrolled through LaMOMS get prenatal care, delivery, and treatment for any conditions a provider determines could affect the health of the pregnancy.9Louisiana Department of Health. Pregnant Women Group Eligibility Policy Postpartum coverage runs for a full 12 months after delivery.
Louisiana’s Take Charge family planning waiver covers women 19 to 44 who don’t qualify for full Medicaid. It pays for up to four annual physical exams with lab work, contraceptive counseling, prescription birth control (pills, patches, injections, IUDs, diaphragms), and sterilization procedures.10Louisiana Department of Health. Take Charge Family Planning Family planning services under full Medicaid are also exempt from copays.
What Children Under 21 Get
Through the federally required Early and Periodic Screening, Diagnostic, and Treatment benefit, children on Louisiana Medicaid get a much wider range of services than adults. The underlying rule is that if a child has a medical need and Medicaid can cover the treatment, it should be covered, even if the same service isn’t available to adults.
Covered services for children include:
- Dental exams, cleanings, fluoride treatments, fillings, and extractions starting when the first tooth appears
- Eye exams, eyeglasses, hearing aids, and audiological services
- Psychological evaluations, therapy, psychiatric hospital care, applied behavioral analysis, and mental health rehabilitation
- Speech and language, occupational, and physical therapy
- Durable medical equipment, appliances, and supplies
- Home health and personal care services
- Prescription drugs
- Chiropractic services and podiatry
Louisiana’s program also notes that children may qualify for “any other medically necessary health care, diagnostic services, treatment, and other measures” Medicaid can cover.8Louisiana Department of Health. Services Available to Medicaid-Eligible Children Under 21 If your plan denies a service for your child, that broad standard is worth pointing to on appeal.
Adult Dental vs. Child Dental
Children get comprehensive dental care from the first tooth onward: exams, X-rays, cleanings and fluoride every six months, fillings, and extractions.11Louisiana Department of Health. Dental Plan Comparison Chart
Adults 21 and over do not get routine cleanings, fillings, or restorative care on natural teeth. What adults do get:
- Simple tooth extractions, with a $200 limit, plus up to three teeth pulled when being fitted for dentures
- One complete set of dentures every eight years if six or fewer natural teeth remain, plus annual denture repairs
- Diagnostic X-rays and exams, but only when you’re being fitted for dentures or partials
- A free cleaning and exam if you visit a dentist within seven days of a hospital emergency visit for non-trauma dental care
That last benefit is easy to miss. If you end up in the ER with a dental problem, booking a dentist within the week unlocks a covered cleaning and exam.11Louisiana Department of Health. Dental Plan Comparison Chart
Vision Care
Eye exams are covered for Medicaid members under 21, limited to one exam per calendar year. Eyeglasses are covered for children too, including frames in metal or plastic and medically necessary lenses. Up to three pairs per year are covered without extra review; a fourth pair requires documentation of medical need.12Louisiana Department of Health. Vision Eyewear Services – Covered Services If a child’s glasses break, the manufacturer’s warranty is the first option; if that’s expired, Medicaid covers repair or replacement. Bifocal, trifocal, and polycarbonate lenses require prior authorization and are approved only when medically necessary, for example when a child is blind in one eye or has seizures that make falls likely.
Routine eye exams and eyeglasses for adults 21 and over are not covered under the standard benefit. Some managed care plans add limited vision perks, so it’s worth checking with your plan directly.
Long-Term Care at Home or in a Facility
Louisiana covers long-term care for people who need ongoing help with daily activities because of age, illness, or disability. You can qualify for a nursing facility or, in many cases, for services that let you stay in your own home.
Nursing Facility Care
Nursing facility services cover skilled nursing, medical care, rehabilitation, and health-related services that can’t be delivered in the community. You have to meet both the long-term care financial rules and the nursing facility level of care standard set by the Office of Aging and Adult Services.6Louisiana Department of Health. Medicaid Services The Louisiana Options in Long Term Care helpline is 1-877-456-1146.
Staying at Home
If you qualify for nursing facility care but want to stay home, the Community Choices Waiver is the broadest option. It covers personal assistance with daily activities, adult day health care, respite for caregivers, home-delivered meals, home accessibility modifications, personal emergency response systems, nursing, skilled therapy, assistive technology, and housing stabilization services.13Louisiana Medicaid. Community Choices Waiver
The Long Term–Personal Care Services program is a narrower alternative for people at home who meet the nursing facility level of care. It covers grooming, bathing, eating assistance, meal preparation, household chores, and accompanying you to medical appointments.14Louisiana Department of Health. LT-PCS Fact Sheet You can’t be on the Community Choices Waiver and LT-PCS at the same time.
The Program of All-Inclusive Care for the Elderly coordinates checkups, home health, and long-term care for older adults in a single program.15Louisiana Department of Health. OAAS Home and Community Based-Services
Rides to Appointments and Medical Equipment
If you need to get to a Medicaid-covered appointment and have no other way to get there, non-emergency medical transportation is covered. A transportation broker arranges the least costly option that fits your needs, whether that’s a sedan, a wheelchair-accessible van, or a public transit pass.16Louisiana Medicaid. Medical Transportation Schedule the ride a few days ahead through your managed care plan or the broker.
Medically necessary equipment like wheelchairs, hospital beds, and oxygen is covered when ordered by your doctor.1Louisiana Department of Health. Medicaid Services Chart For some equipment, your doctor has to have seen you within six months before writing the order. Most durable medical equipment also needs prior authorization from your health plan.
What You’ll Pay Out of Pocket
Copays in Louisiana Medicaid are small. The prescription copays listed above top out at $3.00 per fill, and that’s the cost most adults will run into. Children under 21, pregnant women, nursing facility residents, hospice patients, and home and community-based waiver recipients owe nothing at the pharmacy.4Louisiana Department of Health. Pharmacy Copayment Schedule Preventive services, emergency services, and family planning services are also copay-free. A provider cannot turn you away because you can’t pay a copay; that’s a federal protection.
If a Service Gets Denied
If your health plan denies a service or approves something different from what was requested, appeal to the plan first. The decision letter will explain how to request a State Fair Hearing afterward if you still disagree.17Louisiana Department of Health. How to Appeal Medicaid
One deadline matters more than any other. If you file your appeal within 10 days of the denial, your current services continue while the appeal is reviewed. After 10 days you can still appeal (federal law gives you up to 90 days), but you’ll go without the service while you wait.18eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries Disability Rights Louisiana (1-800-960-7705) can help you work through the process.
One Thing Coverage Doesn’t End At: Estate Recovery
Coverage comes with one feature most people don’t learn about until later. Federal law requires every state, including Louisiana, to seek repayment from the estates of Medicaid recipients who were 55 or older when they received certain services, specifically nursing facility care, home and community-based services, and related hospital and prescription drug costs.19Medicaid.gov. Estate Recovery
Louisiana can’t pursue recovery while you’re survived by a spouse, a child under 21, or a child of any age who is blind or disabled; recovery is deferred until those conditions no longer apply. Recovery must be waived when it would cause undue hardship on any child of the deceased, may be waived when it wouldn’t be cost-effective, and can be reduced by documented maintenance expenses when heirs kept up the family home during nursing facility or home-based care.20Cornell Law Institute. Louisiana Admin Code Title 50 I-8103 – General Provisions Estate recovery is not a condition of getting coverage, and you’re notified about it when you apply.