Louisiana’s Medicaid program, known as Healthy Louisiana, provides coverage for chiropractic services, though the rules and limitations differ significantly based on the beneficiary’s age. Because the program is managed by multiple private Managed Care Organizations (MCOs), the specific rules for accessing this benefit are divided into state-mandated coverage for children and an optional, MCO-provided benefit for adults.
Coverage Status in Healthy Louisiana
Chiropractic services are covered for eligible beneficiaries in Louisiana, but the pathway to access depends on the age of the recipient. For those under the age of 21, these services are covered under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit, which mandates comprehensive and preventive care for children in Medicaid. Services covered under this program must be medically necessary to correct or improve physical or mental conditions.
Beneficiaries aged 21 and older typically access this care through “In Lieu of Services” (ILOS), which is an added benefit offered voluntarily by the MCOs. These ILOS benefits are medically appropriate alternatives to services covered under the standard state plan. The coverage of manual manipulation of the spine is the core component of the chiropractic benefit, as defined by federal Medicaid guidelines. The Louisiana Department of Health oversees these policies, ensuring MCOs adhere to the defined scope and duration of services for both age groups.
Specific Limitations and Visit Requirements
The number of covered chiropractic visits is strictly limited and is contingent upon the beneficiary’s age and the medical necessity of the treatment. For beneficiaries between the ages of five and twenty, the program covers a maximum of twelve different dates of service per fiscal year without requiring a separate prior authorization. This limit applies to the medically necessary manual manipulation of the spine.
For those aged 21 and older receiving care through the MCO’s In Lieu of Service benefit, the limit is often eighteen treatment sessions annually that do not require prior authorization. A treatment session is defined as all chiropractic services that occur on a single date of service. Beyond this core service, the adult benefit may also cover ancillary procedures, such as up to two non-manipulative therapies per date of service, tailored to the treatment plan.
In all cases, the initial visit must result in a documented treatment plan that includes the necessary level of care, the expected duration and frequency of visits, and clear treatment goals. Spinal manipulation is covered for up to five regions of the spine when included in the treatment plan. Louisiana Medicaid typically does not impose co-payments for state plan services for children or for many essential services for adults.
Navigating Referrals and Prior Authorization
Accessing chiropractic services requires navigating the referral and prior authorization (PA) system, which varies by age group. For beneficiaries aged five through twenty, the twelve visits covered per fiscal year must be the result of a referral from a licensed EPSDT medical screening provider or Primary Care Provider (PCP). Children from birth through four years of age have a stricter requirement, as every date of service must be prior authorized by the fiscal intermediary before the first treatment is administered.
For adults aged 21 and older utilizing the MCO’s ILOS benefit, a referral from a PCP is generally not required to access the initial treatment sessions. PA becomes necessary when treatment exceeds the established visit limits for both children and adults. The treating chiropractor is responsible for submitting the PA request to the MCO, which must include documentation such as the treatment plan, necessary X-rays, and evidence of medical necessity.
Routine prior authorization requests should be submitted at least seven business days before the service is scheduled to be delivered. MCOs typically process routine authorization requests within five business days, but the decision may take up to fourteen calendar days if additional clinical information is needed. Providers must obtain prior authorization before the services are rendered to ensure payment for the care.
Finding Participating Chiropractors
Locating a chiropractor who participates in the Healthy Louisiana program is necessary for accessing covered services. Since the program is administered through Managed Care Organizations, the most reliable method is to consult the specific provider directory for the beneficiary’s MCO. Major MCOs operating in the state include Aetna Better Health, Healthy Blue, Humana Healthy Horizons, and Louisiana Healthcare Connections.
These MCOs maintain online search tools that allow beneficiaries to filter providers by specialty and location. Beneficiaries can also call the member services number on their insurance card to request a list of in-network chiropractors. After identifying a potential provider, it is advisable to contact the chiropractor’s office directly to confirm they are accepting new Healthy Louisiana patients and are fully aware of the state’s specific coverage rules and prior authorization requirements.