Get La Moms

This guide provides clear and comprehensive instructions on how to fill out the La Moms form for access to Louisiana's Medicaid program for pregnant women. By following these steps, users will be able to complete their application accurately and efficiently.

Follow the steps to successfully complete your La Moms application.

1. Press the 'Get Form' button to obtain the La Moms application form and open it in your preferred editing tool.
2. Begin by filling out the personal information section. Enter your full name, including first name, middle initial, and last name, as well as your maiden name if applicable. Provide your Social Security Number and date of birth.
3. In the next section, indicate your race/ethnic background if you choose to do so. This information is optional. Additionally, provide your place of birth and confirm your U.S. citizenship status.
4. Provide your mailing address and contact information, including home phone, daytime phone, and email address. Make sure to indicate the best time to reach you.
5. Next, estimate your due date and specify if you are expecting more than one baby. Provide details about your legal partner if applicable.
6. List all children under the age of 19 who live with you. Provide their names, dates of birth, and any relevant details.
7. Detail your income and that of your partner, if applicable. Include information about any wages, social security, unemployment, and any other income sources.
8. Indicate whether you have health insurance and provide details about your policy if applicable.
9. Complete the application by signing and dating the form, confirming the accuracy of the information provided.
10. Once completed, submit your application. You can save changes, download, print, or share the La Moms form as needed.

Complete your La Moms application online today to access crucial health services for you and your baby.