Hurricane Isaac Emergency Provider Enrollment Packets

Louisiana Medicaid

Emergency Provider Enrollment Process in Event of Declared Voluntary or Mandatory Evacuation

Hurricane Isaac—Dates of Service 8/27/12 – 11/24/12

For Services Performed Out of State (non-Louisiana)

When Louisiana Medicaid enrollees evacuate out of state as a result of a declared voluntary or mandatory evacuation, the following enrollment packets are available to enroll out-of-state providers in Louisiana Medicaid and assure continuity of health care for Louisiana Medicaid enrollees.

Disaster Enrollment Packet for Entities/Businesses 8/2012

Disaster Enrollment Packet for Individuals 8/2012

Louisiana Medicaid Provider numbers issued to providers for evacuation-related recipient care are automatically closed after 90 days.

After completing the enrollment packet materials, please return all forms with to:

Molina Medicaid Solutions Provider Enrollment Unit
PO Box 80159
Baton Rouge, LA 70898-0159
nrollment Packets can also be faxed to 225-216-6392

In-State Louisiana based providers (not currently enrolled with Louisiana Medicaid) who rendered emergency services due to Hurricane Isaac to Louisiana Medicaid Recipients, must complete and mail in a full enrollment application found here.