Paper Application and Forms

Application for Health Coverage

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

Spanish   Vietnamese

Extra Person Page

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

Spanish   Vietnamese

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.

Spanish   Vietnamese

Medicare Savings Program Application

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

Spanish   Vietnamese

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.

Spanish   Vietnamese