AmeriHealth Caritas Louisiana

What AmeriHealth Caritas Louisiana does

AmeriHealth Caritas Louisiana is a Medicaid managed care health plan headquartered in Baton Rouge, Louisiana, operating under the state's Healthy Louisiana program. Founded in 2012, the company is a wholly-owned subsidiary of AmeriHealth Caritas, a national managed care organization focused on serving underserved populations. AmeriHealth Caritas Louisiana provides comprehensive Medicaid coverage — including medical, dental, pharmacy, mental health and substance use treatment, vision, and preventive care — to eligible beneficiaries across all Louisiana parishes. The plan delivers services through a contracted provider network, with member-facing digital tools including a Member Portal, native iOS and Android mobile apps, a 24/7 Nurse Call Line, and non-emergency medical transportation. Specialized clinical programs include the Bright Start maternity program, EPSDT services for children under 21, sickle cell disease management, and integrated behavioral health services.

The company's operating model is built on per-member-per-month (PMPM) capitation payments received from the Louisiana Department of Health, with no direct premiums charged to eligible Medicaid beneficiaries. Community engagement is a defining operational feature, delivered through physical Community Wellness and Opportunity Centers in New Orleans and Shreveport, a Mobile Wellness and Opportunity Center, and an Enrollee Advisory Council including Youth and Hispanic chapters. The technology architecture relies on third-party platforms — NaviNet for provider portal, HealthSparq for provider directory, DarwinRx for pharmacy locator, and StayWell for health education — integrated with the company's own member portal and CMS-compliant interoperability standards. Operational performance disclosed for 2025 shows 87,451 standard authorizations processed at an 87.98% approval rate and 1,821 expedited authorizations at a 93.19% approval rate, with average decision times of 1.78 days and 14.14 hours respectively. The plan holds NCQA accreditation and operates with HIPAA and CCPA compliance, with 2026 benefit enhancements including a $750 annual adult dental benefit.

Name

AmeriHealth Caritas Louisiana

Legal name

AmeriHealth Caritas Louisiana

Website

https://amerihealthcaritasla.com

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

11–50 employees

Short description

AmeriHealth Caritas Louisiana is a Medicaid managed care health plan serving eligible Louisiana beneficiaries through the Healthy Louisiana program, providing medical, dental, pharmacy, and behavioral health services via a contracted provider network, community wellness centers, and digital member tools.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Health Care and Social Assistance (62)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

Keywords

• Medicaid managed care
• Health plan administration
• Behavioral health services
• Pharmacy benefit management
• Maternal care management

Headquarters

HQ city

Baton Rouge

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medicaid Capitation Payments: Receives per-member-per-month (PMPM) capitation payments from the Louisiana Department of Health (LDH) for providing covered Medicaid services to enrolled members. Revenue is predictable based on enrollment volume and varies by member category.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels9 records

Core offering

AmeriHealth Caritas Louisiana is a Medicaid managed care health plan that contracts with the Louisiana Department of Health under the Healthy Louisiana program to deliver comprehensive healthcare coverage to eligible Louisiana residents. The plan covers medical, preventive, dental (with $750 annual adult dental benefits effective 2026), pharmacy, vision, mental health, substance use treatment, and non-emergency medical transportation services, supported by a member portal, provider portal, native mobile applications, a 24-hour nurse call line, and community-based wellness programs including the Bright Start maternity program, EPSDT children's program, and sickle cell disease management.

Product overview

AmeriHealth Caritas Louisiana is a Medicaid managed care health plan operating under the Healthy Louisiana program. The plan provides comprehensive healthcare coverage through a core Medicaid health plan, supported by integrated digital platforms including a member portal, provider portal (NaviNet), and mobile applications. Key clinical programs include mental health and substance use treatment services, the Bright Start maternity program, EPSDT children's services, and pharmacy benefits. The plan also operates community outreach through physical wellness centers in New Orleans and Shreveport, a mobile wellness unit, and an enrollee advisory council. Member-facing digital tools include a StayWell health library with interactive quizzes and calculators, a 24-hour nurse call line, and non-emergency medical transportation services. All services are coordinated through the member portal with provider administration handled via the NaviNet platform.

Differentiator

Problem solved

Functional benefit

Brands

• Bright Start: Maternity care program designed to help pregnant members make healthy choices for themselves and their unborn babies. Includes prenatal care coordination, health education, and postpartum support.
• Nurse Call Line
• Member Portal

Products and services

• AmeriHealth Caritas Louisiana Medicaid Health Plan A Medicaid managed care health plan operating in Louisiana under the Healthy Louisiana program, providing comprehensive medical coverage, preventive care, mental health services, and pharmacy benefits to eligible members across all Louisiana parishes.
• Member Portal Secure online portal allowing members to view claims, track health history, manage prescriptions, complete health assessments, choose primary care providers, and access health education resources.
• NaviNet Provider Portal Web-based platform for in-network healthcare providers to manage administrative tasks including claims submission, eligibility verification, and prior authorization requests.
• AHC Mobile App Native mobile applications for iOS and Android enabling members to access health plan features, view benefits, find providers, and manage their healthcare on mobile devices.
• Mental Health and Substance Use Treatment Services Comprehensive behavioral health program covering mental illness, substance use disorders, addiction services, inpatient and outpatient treatment, crisis intervention, psychiatric rehabilitation, and autism spectrum services for eligible Medicaid members.
• Bright Start Maternity Program Maternity care program providing prenatal education, high-risk pregnancy case management, childbirth classes, and postpartum support to pregnant members at no cost.
• EPSDT (Early and Periodic Screening, Diagnosis and Treatment) Special healthcare program for members under 21 years of age covering well-child visits, immunizations, developmental screenings, and treatment for childhood diseases and illnesses.
• Pharmacy Benefits Prescription drug coverage including generic and brand-name medications, prior authorization management, and access to a network of participating pharmacies with limited copays subject to the 5% of family income monthly threshold.
• 24-Hour Nurse Call Line Free 24/7 telephone nurse hotline (1-888-632-0009) providing medical information, triage guidance, and care recommendations for members when their doctor's office is unavailable.
• Non-Emergency Medical Transportation (NEMT) Transportation services to help members get to medical appointments when they have no other means of transportation, accessed via 1-888-913-0364.
• Community Wellness and Opportunity Centers Physical community centers in New Orleans and Shreveport offering health education, member benefit navigation, health screenings, safety awareness events, baby showers, exercise classes, community resource information, and computer lab access to members at no cost.
• Mobile Wellness and Opportunity Center State-of-the-art mobile unit providing community services including health education, screenings, fitness classes, nutrition demonstrations, and job readiness events at no cost to members in easy-to-access locations across Louisiana.
• Health Needs Assessment (HNA) with Rewards Online or telephonic health survey that evaluates member health status and provides personalized health recommendations, with cash rewards ($50 online, $30 by phone) offered to members for completion.
• 2026 Enhanced Adult Dental Benefits Enhanced annual adult dental benefit covering exams, cleanings, fillings, extractions, and X-rays with a $750 annual maximum effective 2026.

Quantifiable outcome

• Standard prior authorization approval rate: 87.98% (76,939 of 87,451 requests)
• +3 more outcomes

Named customers1 record

Segments6 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration8 records

Feature4 records

Partnerships

Ten partnerships are on record, tiered core and minor.

• Louisiana State University Health Sciences Center (LSUHSC) School of Medicine and School of Public HealthcoreStrategic or Co-development Partner · 1 January 2016Health Policy Honors Program partnership providing LSUHSC medical students with foundation in health policy analysis and research. Students complete the program by serving as Policy Fellows in Washington, D.C. Program led by Professor Peggy A. Honoré, MHA, DHA. Launched in 2016.
• Association of Community Affiliated Plans (ACAP)minorStrategic or Co-development PartnerMargaret Richard, LSUHSC medical student, completed an eight-week policy fellowship at ACAP in Washington, D.C. in August 2023. Research focused on behavioral health workforce, telemedicine, school-based mental health services, and mobile crisis interventions.
• United Way of Southeast LouisianaminorStrategic or Co-development PartnerHurricane relief partnership following Hurricane Ida. Collaborated to provide hurricane relief supplies to residents of LaPlace and surrounding communities.
• St. John United WayminorStrategic or Co-development PartnerHurricane relief partnership following Hurricane Ida for providing relief supplies to affected Louisiana communities.
• Southern Region Minority Supplier Development CouncilminorOthersSupplier diversity partnership supporting minority-owned businesses in the communities served by AmeriHealth Caritas Louisiana.
• Women's Business Enterprise Council (WBEC) SouthminorOthersSupplier diversity partnership supporting women-owned businesses through the Women's Business Enterprise Council South.
• Shreveport Chamber of CommerceminorOthersChamber of commerce partnership for community engagement and business development in Shreveport area.
• Baton Rouge Chamber of CommerceminorOthersChamber of commerce partnership for community engagement and business development in Baton Rouge area.
• New Orleans Black Chamber of CommerceminorOthersChamber of commerce partnership supporting Black-owned businesses in the New Orleans area.
• New Orleans Hispanic Chamber of CommerceminorOthersChamber of commerce partnership supporting Hispanic-owned businesses in the New Orleans area.

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Louisiana Healthcare Connections: Centene Corporation's Medicaid managed care plan in Louisiana, competing directly for the same Medicaid beneficiaries. Offers comparable benefits including behavioral health, maternity care, and chronic disease management programs.
• Humana Healthy Horizons Louisiana: Humana's Medicaid managed care plan in Louisiana, serving Medicaid beneficiaries through the Healthy Louisiana program. Competes directly on member experience, provider networks, and care management programs.
• Aetna Better Health Louisiana: CVS Health's Medicaid managed care plan serving Louisiana Medicaid beneficiaries. Direct competitor in the Same Healthy Louisiana program with similar capitated service model and member services infrastructure.
• AmeriHealth Caritas: Parent company of AmeriHealth Caritas Louisiana, operating affiliated health plans across multiple states. Provides shared infrastructure, technology, and clinical programs that the Louisiana plan leverages.
• UnitedHealthcare Community Plan Louisiana: UnitedHealth Group's Medicaid managed care offering in Louisiana, competing for the same Medicaid population. Benefits from UnitedHealth's national scale and integrated provider capabilities.
• Healthy Blue Louisiana: Anthem Blue Cross Blue Shield's Medicaid managed care plan in Louisiana, directly competing with AmeriHealth Caritas Louisiana for Healthy Louisiana enrollees. Operates under the same state Medicaid contract framework with similar benefit offerings.

Broad incumbents

• CareSource: Large nonprofit Medicaid managed care plan operating across multiple states with similar mission-driven focus on serving underserved populations. Comparable capitated model and member engagement approach.
• Molina Healthcare: Major national Medicaid managed care operator with plans in multiple states. While not currently in Louisiana, operates similar capitated Medicaid models with comparable member services and quality programs.
• Centene Corporation: The largest Medicaid managed care company in the United States, with multiple state plans including Louisiana Healthcare Connections. Operates broadly across Medicaid, Marketplace, and other government programs.

Others

• Highmark Wholecare: Medicaid managed care plan affiliated with Highmark Blue Cross Blue Shield serving Pennsylvania and other markets. Provides regional competition insights and comparable capitated Medicaid operations though in different geographies.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/AmeriHealthLA
• Facebookfacebook.com/AmeriHealthLA
• Instagraminstagram.com/amerihealthla
• LinkedInlinkedin.com/company/amerihealth-caritas-louisiana

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about AmeriHealth Caritas Louisiana