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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



211 - Get Connected. Get Answers.

Medicaid Renewal Forms

Renew your Louisiana Medicaid health coverage online at Louisiana Medicaid Online Services or call Medicaid at 1-888-342-6207. If you want a paper renewal form, see the list below. If you can't decide which one to fill out, use the General Renewal Form.

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Renewal Form Spanish Translation Vietnamese Translation

LaCHIP

For children under 19.

(Spanish) (Vietnamese)

Take Charge

For women aged 19 - 44.

(Spanish)  

General Renewal Form

Used for any Medicaid Program.

(Spanish) (Vietnamese)

Medicaid Savings Program

For Medicare recipients.

   

Medicaid Purchase Plan

For working people living with a disability.

   

Breast & Cervical Cancer

For women who have cervical or breast cancer.

   

Long Term Care

For someone who lives in a nursing facility or group home.

   

HCBS Waivers and PACE

For someone who gets Home and Community Based Waiver services or PACE.