CommunityCARE is a comprehensive health delivery system, which links Medicaid members to a Primary Care Provider (PCP). The PCP manages the care of each CommunityCARE member by providing health education, preventive care, and acute care and refers the member to specialists when needed. The PCP also admits members to the hospital. The PCP shares medical information with the emergency room and other authorized health care providers. The CommunityCARE PCP arranges for medical care coverage 24-hours a day, seven days a week. PCPs are reimbursed fee-for-service payment for care provided and a monthly management fee for each CommunityCARE member linked to their practice.

Each CommunityCARE member is linked to a PCP which creates a medical home. The medical home is the first place members turn to for their health care needs. The PCP performs the responsibilities mentioned earlier and establishes an on-going relationship with each CommunityCARE member. There are many different types of CommunityCARE PCPs to choose from: Physicians certified in Family Practice, General Practice, Pediatrics, Internal Medicine, and certain Obstetricians/Gynecologists, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

The CommunityCARE Program was developed to ensure access to quality care for Medicaid eligibles in the CommunityCARE Program by: providing a "medical home"; strengthening the patient/physician relationship; promoting the educational/preventive aspects of health care; and promoting the responsibility of the member to use emergency room and other services appropriately, thereby reducing the cost associated with inappropriate and duplicative services.

CommunityCARE members are entitled to the same Medicaid covered services as those eligibles not in CommunityCARE. Providers and CommunityCARE members need to be familiar with the policies specific to CommunityCARE such as referrals, prior authorization and appropriate use of the emergency room which may determine the service being deemed "covered."

Who is eligible for CommunityCARE?
Most low-income families with children, disabled adults and children who are Medicaid members are required to participate in CommunityCARE except:

• Members who are 65 years or older
• Members with Medicare benefits, including dual eligibles
• Foster children or children receiving adoption assistance
• Hospice Members
• Office of Youth Development clients (children in State custody)
• Members in the Medicaid Physician/Pharmacy Lock-In Program (members that are pharmacy-only Lock-In are not exempt)
• Members who have other primary insurance with physician benefits, including HMOs
• Members who have an eligibility period of less than 3 months
• Members who have retroactive only eligibility (CommunityCARE does not make retroactive linkages)
• Native American Indians who reside in parish of Reservation (currently Jefferson Davis, St. Mary, LaSalle and Avoyelles parishes)
• Certain medically high risk members may warrant the direct care and supervision of a non-primary care specialist. Requests for medical exemptions are reviewed for approval on a case by case basis. Requests must be submitted in writing, along with supporting medical documentation of the member's medical condition(s). Requests for medical exemption should be mailed to: DHH-CommunityCARE Program , P.O. Box 91030, Baton Rouge, LA 70810, Attention: Veronica Dent, Program Supervisor. A preprinted request form is available on the CommunityCARE web site, www.la-communitycare.com.
• Medicaid eligibles in the PACE program
• Members in pregnant woman eligibility categories
• SSI members under the age of 19
• Members under the age of 19 in the NOW and Children's Choice waiver programs
• Members under the age of 19 in the supports waiver and supports waiver SSI programs
• Members in the family planning waiver program
• Members in the LaCHIP Affordable Plan

If you would like to apply for Medicaid, are interested in learning more about the CommunityCARE Program, or have any other general Medicaid inquiries, please call the Louisiana CommunityCARE Toll-Free Hotline at 800.259.4444 or visit The Louisiana Medicaid Online Application Center.

Who can be a CommunityCARE Provider?
General practitioners, family practitioners, pediatricians, internist, OBGYNs, FQHCs, RHCs & Academic Health Center Teams who meet the following requirements:

1. Certified LA Medicaid provider
2. Provide or arrange for KIDMED screenings
3. Hospital admitting privileges or arrange for admission
4. Availability and Access to Linked Members

If you are a medical provider and would like to enroll in the CommunityCARE program, please call our provider service office at 800.259.4444 or go to the forms page to follow our mailing process.