Louisiana Medicaid: Medical coverage

We cover all medically necessary Medicaid-covered services for our Humana Healthy Horizons® in Louisiana members, including services that:

• Meet your medical needs as ordered by your healthcare provider
• Help you achieve age-appropriate growth and development
• Help you attain, maintain, or regain functional capacity

See your Member Handbook for a full list of your coverage and benefits

Humana Healthy Horizons in Louisiana members get all medically necessary Medicaid-covered services at no cost. See your Member Handbook for information about:

• When prior authorization (preapproval) is needed
• When a referral is needed
• Service definitions
• If the service has eligibility requirements (e.g., some services may be available only to members under age 21, etc.)

Covered medical services include:

Physical health services

• Allergy testing and allergen immunotherapy
• Ambulatory surgical services
• Anesthesia
• Applied behavior analysis therapy (ages 0–20)
• Audiology services
• Bariatric surgery
• Breast surgery
• Chiropractic services (ages 0–20)
• Cochlear implant (ages 0–20)
• Diabetes self-management training
• Durable medical equipment, prosthetics, orthotics, and certain supplies
• Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services (ages 0–20)
• Emergency services
• End-stage kidney disease services
• Eye care and vision services
• Family-planning services
• Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) services
• Genetic testing
• Glasses, contacts, and eyewear
• Gynecology
• Home health-extended services (ages 0–20)
• Home health services
• Hospice services
• Hospital services
• Inpatient hospital services
• Outpatient hospital services
• Hyperbaric oxygen therapy
• Immunizations
• Intrathecal baclofen therapy
• Laboratory and radiology services
• Limited abortion services
• Medical transportation services
• Newborn care and discharge
• Obstetrics
• Pediatric day healthcare services (ages 0–20)
• Personal care services (ages 0–20)
• Pharmacy services
• Physician-administered medication*
• Physician/professional services
• Podiatry services
• Preventive services for adults (ages 21 and older)
• Sterilization
• Telemedicine/telehealth
• Therapy services
• Tobacco cessation services
• Vagus nerve stimulators

We will not pay for services or supplies you receive that Medicaid does not cover, including:

• Any service (drug, device, procedure, or equipment) that is not medically necessary
• Experimental/investigational drugs, devices, procedures, or equipment, unless approved by the secretary of the Louisiana Department of Health
• Cosmetic drugs, devices, procedures, or equipment
• Assistive reproductive technology for treatment of infertility
• Elective abortions (those not covered in the Louisiana Medicaid State Plan) and related services
• Surgical procedures discontinued before completion
• Harvesting of organs when a Louisiana Medicaid member is the donor of an organ to a non-Medicaid member
• Provider-preventable conditions

We will cover medically necessary services you need outside of Louisiana when you meet any of the following conditions:

• Medical services are needed because of a medical emergency
• Medical services are needed and your health would be endangered if you were required to travel to Louisiana
• We determine, on the basis of medical advice, that the needed medical services, or necessary supplementary resources, are more readily available in the other state
• It is general practice for members in a particular locality to use medical resources in another state

You may need approval before getting some services. This preapproval is called prior authorization.

To learn more about prior authorization:

• Refer to your Member Handbook
• Call Member Services at 1-800-448-3810 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m.

You, your authorized representative, or a provider can submit a prior authorization request on your behalf.

Where should you go to see a doctor? You have choices.

Learn where to get care depending on the care you need.

To find a doctor, specialist, hospital, healthcare facility, or other type of in-network service provider:

• Use our Find a Doctor service

• Call Member Services at 1-800-448-3810 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m.