Handbooks and Forms

Member Handbooks

• Integrated Care for Physical and Behavioral Health (PDF) 
  For most members, including those in the Medicaid Expansion; TANF; LaCHIP; Foster Care; Pregnant Women; and Aged, Blind and Disabled Adults programs
  

• Specialized Mental Health and Substance Use Treatment Only (PDF) 
  For members receiving Home and Community Based Services (HCBS), who are dual eligible for Medicaid and Medicare, or who are residing in a health care facility. 
  

• A Guide to Using Your Secure Member Portal (PDF)

Forms

• Health Information Form PDF (complete Health Information form online)
• Notification of Pregnancy PDF (complete Notification of Pregnancy form online)
• Change Your Primary Care Provider (PCP) PDF (complete PCP Change form online)
• Grievance and Appeal (PDF)
• State Fair Hearing for Appeal (PDF)
• Recommendation or Concern (PDF)
• Personal Appeal Representative (PDF)
• Permission to Share My Information (PDF)
• Cancel Sharing My Information (PDF)
• Consent for Sterilization (PDF)

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