LA E&E - Self Service Portal

Submit an Application without Creating an Account

Important Information

There are three steps needed to start an application without an account. Keep in mind that this is a secure website run by the Louisiana Department of Health. By law, we must keep your information private and secure. Please note that you will NOT be able to check your application status, report changes, request a replacement card, submit a renewal, or view your current health coverage benefits. You will also not be able to save and exit, so you will have to complete your application in one sitting.

If you would like to create an account and have the ability to check your application status, report changes, request a replacement card, submit a renewal, or view your current health coverage benefits, please click here. If you already have an online account, click here to log in to your account.

If you have questions about setting up your account, please call the Customer Service Center at 1-888-342-6207.

Some items have an asterisk (*) next to them. You must fill these items in before you can start your application.

Step 1: Create E-Signature PIN

In order to submit an application, you will need to create a PIN. You should choose something that's easy for you to remember but hard for other people to guess. Keep in mind that you will need your PIN when electronically signing anything you submit to LDH. So it's a good idea to write this down and keep it in a safe place as you will not be able to change it later on.

PIN must be 6 numbers long and can only contain numeric characters (0-9).

* PIN:

Step 2: Security Check

Please enter the letters and/or numbers you see below. If you cannot tell what letter or numbers are being displayed, click on the "Refresh" button and the system will display new letters and/or numbers. If you are using screen reader software or cannot tell what the letter and/or numbers are, you can click on the "Listen" button and the system will read them to you (please note: your computer must be able to play sound and your volume must be on for this to work).

* Enter the letters and/or numbers you see above:

Step 3: User Acceptance Agreement

End User Agreement
General
This Website (“Website”) is offered to you, the user (“User”), conditionally upon acceptance of the terms and conditions herein, without modification. User access and use of this site constitutes acceptance of these terms and conditions.

This Website is a State of Louisiana (“State”) computer system, provided as a public service. The general public may use this system to conduct business with the State. User agrees to use this Website as permitted by applicable local, state, and federal laws. User agrees, therefore, not to: 1) knowingly and without authorization, alter, damage, or destroy the State’s or another user’s computer system, network, software, program, documentation or data contained therein; 2) use this service to conduct or attempt to conduct business or solicit the performance of any activity that is prohibited by law. In addition, taking any action which results in blocking access to this Website by other users will be deemed an unauthorized use.

Anyone using this system expressly consents to administrative monitoring at all times. You (User) are further advised that system administrators may provide evidence of possible criminal activity identified during such monitoring to appropriate law enforcement officials. If you (User) do not wish to consent to monitoring, please exit this system immediately.

Account Creation
To create your account, you will be asked to provide your name, your email address, a User ID, and a Personal Identification Number (PIN). The PIN will be used as your electronic signature. You may be required to provide your PIN in the event that you are unable to recover your password and need to have a temporary password issued to you by the State. You have the choice to opt out and not provide the requested information. However, if you choose not to create an account, you will not be able to complete your transaction over the Internet. You also have the opportunity to review, delete or update the information stored in your user profile. The information collected to create a user account is limited to what is required to provide secure access to State services. Access to other services may require additional information to be provided. Some information you provide in the course of conducting business with the State may be shared with other state and federal agencies as required or allowed by law.

Protecting Your Account
Your User ID, password, and PIN are your keys to securely conducting business with the State over the Internet. Your User ID, password, and PIN should not be shared with anyone. Your password is known only to you and is unavailable to anyone, including State information security officers and administrators. It is your obligation to protect it by keeping it private and confidential. Inactive User Accounts may be purged based on current State policies and procedures.

Information systems, and the data that is stored and managed by the State, are governed by state and federal laws, rules and regulations. Violators may be subject to prosecution, fines, or other sanctions.

Reporting Suspicious Activity/Freezing User Accounts
Users of this Website are responsible for reporting, as soon as possible, suspicious activity on your account, or exposure or compromise of passwords, passphrases, or certificates.

If you think that your password may have been compromised or exposed, but have no reason to believe that your account has been used, change your password immediately.
If you believe that your account has been compromised or you find signs of suspicious activity, take the following actions:
1. Notify our Helpdesk immediately at 1-888-342-6207.
2. Do not modify any of the files found in your account.
3. If possible, do not use your account until the issue is resolved.

The State (or any of its second party service provider/s) reserves the right to freeze or suspend any account in the system for an indefinite period if there is suspicion of any illegal activity taking place or for any other reason whatsoever.

Electronic Signatures
The User understands that this Agreement describes my obligations to protect my electronic signature/PIN, and agrees to the following terms and conditions:

I agree that by electing the “I Agree” option below using any device, means or action, I consent to the legally binding terms and conditions of this Agreement.

I further agree that, for the purposes of authorizing and authenticating electronic health records, my electronic signature/PIN has the full force and effect of a signature affixed by hand to a paper document. I also agree that no certification authority or other third party verification is necessary to validate my electronic signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of my electronic signature.

I will use only my electronic signature/PIN to establish my identity and sign electronic documents and forms. I am solely responsible for protecting my electronic signature. If I suspect or discover that my electronic signature/PIN has been stolen, lost, used by an unauthorized party, or otherwise compromised, then I will immediately notify the State and request that my electronic signature/PIN be revoked. I will then immediately cease all use of my electronic signature. I agree to keep my electronic signature/PIN secret and secure by taking reasonable security measures to prevent it from being lost, modified or otherwise compromised, and to prevent unauthorized disclosure of, access to, or use of it or of any media on which information about it is stored.

I will immediately request that my electronic signature/PIN be revoked if I discover or suspect that it has been or is in danger of being lost, disclosed, compromised or subjected to unauthorized use in any way. I understand that I may also request revocation at any time for any other reason.

I am aware that I can choose to enroll using methods other than this Website, including non-electronically signed methods. Should I choose to continue through the sign-up process on this Website, I understand that I may be asked to electronically sign documents that are necessary to complete the transaction through this Website. Electronically signing documents will allow you to submit the documents online and may allow the State to determine your Medicaid eligibility in real time. If you decline to use an electronic signature to sign this application, you will not be able to submit an online application. You will have to print and mail in a paper application or call the Customer Service Unit at 1-888-342-6207. I understand that enrollment through this Website and all its corresponding documents are considered to be a single transaction under La. R.S. 9:2605. Should I decide to switch my enrollment method to an alternative other than this Website, I understand that I may have to restart the enrollment transaction from the beginning, which could result in additional delays.
I acknowledge and agree that I may request a paper version of any electronically signed documents created during the enrollment transaction by printing or saving a copy within the Website or by contacting the State.

Content Restrictions
The use or misuse of any content, except as provided in this Agreement, is strictly prohibited.

This Website, including all content and other information in text, graphical, video and audio forms, images, icons, software, designs, applications, data, and other elements available on or through the Website or its software, is the property of the State and is protected by copyright under both United States and foreign laws. Under the terms of this Agreement, the State grants you a non-exclusive license to use the Website. The State may revoke your license at any time in its sole discretion. Any use of the Website and its content not explicitly permitted by this Agreement is a breach of this Agreement and may violate the law, and if you violate the terms of this Agreement, your permission to use the Website automatically terminates and you must immediately destroy any copies you have made of any portion of the Website content. All rights not expressly granted herein are reserved to the State and its licensors. Your use of the Website does not transfer to you any ownership or other rights.

You may print Website pages provided that you do not modify any of the pages and you do not remove or alter any visible or non-visible identification, marks, notices, or disclaimers. The Website and its content may not be copied, framed, scraped, mirrored, data mined, imitated, reproduced, republished, uploaded, posted, transmitted, modified, indexed, catalogued, or distributed in any way, in whole or in part, without the express prior written consent of the State. You may not sell or resell any part of the Website.

Trademark Information: Louisiana Department of Health, is a trademark and trade name owned or licensed by the State.

Other names and logos appearing on or in connection with the Website may be registered or unregistered trademarks, service marks, trade names and logos of their respective owners.

Any use of the trademarks, service marks, trade names or logos displayed on or in connection with the Website is strictly prohibited, and nothing appearing on or in connection with the Website will be construed as granting, by implication, estoppel, or otherwise, any license or right to use any of those marks.

No framing; links; third party sites: Framing, in-line linking or other methods of association with the Website are expressly prohibited without our prior written approval.

Links to Third Parties’ Websites

The State maintains this Website under the domain of louisiana.gov.
External Links: The State provides links to external sites that may be helpful to the User. However, the State does not offer a link exchange, nor will it link to the personal websites of individuals. Therefore, the State cannot be responsible for content or material displayed on any website connected via hyperlink to this Website.
The State is not responsible for the loss of linked services and may discontinue a site referral link at any time.

Information uploaded
Any information or material you submit to this Website by any means may be used by the State for any purpose it deems necessary or useful to the Website’s purpose, specifically including, but not limited to, developing statistical analyses, user support, and user notification of the current or incomplete application status.

Use of Cookies
A cookie is a small amount of data, which may include an anonymous unique identifier, that is sent to your browser from the Website’s computers and may either be used during your session (session cookie) or may be stored on your computer’s hard drive (persistent cookie). Cookies may contain data about a user’s movements during their visit to the Website. If the browser software on the computer you are using is set to allow cookies, a website can send its own cookie to you. A website that has sent a cookie can only access those cookies it has sent to you; it cannot access cookies sent to you by other sites.

When you request an Account, and use it to access State of Louisiana services over the Internet, a session cookie will be sent to your browser and stored in your computer’s memory. The cookie will be used to maintain session information, so that you do not have to re-enter your authentication information when you navigate to different pages. Your privacy is best protected if you close your browser after signing off from the Website.

Other Software Components
The Website will also download other software components such as a cascading style sheet, images displayed on web pages, and JavaScript objects. These components are downloaded to optimize your user experience with the Website and are used in a manner consistent with other websites that you may visit.

Illegal Activity
Under both federal and state law, it is illegal to knowingly make, use, or cause to be made or used, a false record or statement in the application for Medicaid on this Website. Any violation WILL BE PROSECUTED to fullest extent allowed under the law. ANYONE USING THIS SYSTEM EXPRESSLY CONSENTS TO THE TERMS OF THIS AGREEMENT.

*Please check the box to let us know that you have read and agreed to the Louisiana Department of Health User Acceptance Agreement above.