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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Apply for health coverage or renew existing coverage

Apply or renew coverage online at Louisiana Medicaid Online Services.

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Paper Application and Forms

Application for Health Coverage

Use this form to apply for or renewal coverage for all Louisiana Medicaid programs. Also use this form to apply for help paying for health insurance through the Health Insurance Marketplace.

Solicitud de cobertura de salud , Đơn Xin Bảo Hiểm Sức Khỏe

Extra Person Page

If you have more than 4 people in your home, use these pages to tell us about them.

Página para personas adicionales , Trang phụ

Employer Coverage Tool

If you get insurance through someone's job or if you can get insurance through a job, get your employer to fill out this form so you can tell us about it.

Formulario de cobertura del empleador , Dụng cụ của bảo hiểm từ sở làm việc

Medicare Savings Program Application

Use this form to apply for assistance with your Medicare premium.

Solicitud del programa de ahorros de Medicare , Đơn Xin Chương Trình Nguyệt Liễm Medicare

Long Term Care Application

Use this application for persons who are planning to live or now live in a nursing facility, group home, or developmental center in Louisiana or who have been offered an opportunity for Waiver or PACE in Louisiana.