Skip to Main Content

One of our vendors, Insightin Health, experienced a cybersecurity issue in September 2025. To learn more, view their notice.

Amino Acid-Based Elemental Formula Coverage Update (IB 26-7)

Date: 03/25/26

Louisiana Healthcare Connections is sharing with Providers a recent coverage update to include Amino Acid-Based Elemental Formula.

Effective January 1, 2026, the Louisiana Department of Health (LDH) added amino acid-based elemental formula coverage criteria for Medicaid beneficiaries.

Amino acid-based elemental formula is a covered Medicaid benefit regardless of the delivery method used. Prior authorization is required and must include documentation of the following:

  1. A diagnosis provided by a board-certified allergist or gastroenterologist.
  2. A written order from the treating physician indicating that the amino acid-based elemental formula is medically necessary for the treatment of the child due to any of the following conditions:
  • Immunoglobulin E and non-immunoglobulin E mediated allergies to multiple food proteins;
  • Severe food protein-induced enterocolitis syndrome;
  • Eosinophilic disorders confirmed by the results of a biopsy; or
  • Impaired nutrient absorption caused by disorders affecting the absorptive surface, functional length, or motility of the gastrointestinal tract.

The Durable Medical Equipment (DME) provider manual has been revised to incorporate coverage details for amino acid-based elemental formulas within section 18.2.11, Enteral Nutrition.

For questions regarding this communication, please contact LDH at (225) 342-5691. For questions regarding fee-for-service claims, please contact Gainwell Technologies Provider Relations at (800) 473-2783 or (225) 924-5040.