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Medicaid Emergency Provider Information for Hurricane Evacuees

The Ohio Department of Jobs and Family Services has requested assistance from OPA in getting help for the thousands of refugees coming to Ohio from Alabama, Louisiana and Mississippi who are current Medicaid recipients in those states. Ohio pharmacies can now become providers on an emergency expedited basis in those states. The following information tells you how to get the forms and apply for provider status, and be paid at the rate applicable in that state. HOWEVER, the states specifically request that stores apply for provider status only after knowing that evacuees are residing in the area. They prefer that chain pharmacies only apply for individual pharmacies that will be serving these individuals, or the state’s ability to process provider applications will be overwhelmed! In other words, don’t apply for provider status to show your support for the effort, but only do it if you have reason to believe that your pharmacy will be utilized. We have tried to give you the basic info on each of the programs, but contact info is included, if you need it. Ohio is working to expedite the processing of those evacuees who are not currently on Medicaid in their home state, but find themselves living here without income for some period of time. These states have indicated that they will make the provider status retroactive to August 29th for Alabama and Mississippi, and August 27th for Louisiana.

Thanks for helping these individuals. Please contact OPA if you have any questions at or 614-586-1497.

  • Contact: Kelly Littleton, Health Information Design, 1-334-353-4525
  • Website:
  • Restrictions: Plan covers a maximum 34 day supply with 5 refills for all Rx
    Only 4 brand name medications are authorized per month
  • Patient Cost Sharing: Copays range form $0.50-$3.00 based on cost of drug (does not apply to patients that are pregnant, reside in nursing facilities or those under 18yo.)
  • Dispensing Fee: $5.40
  • Ingredient Reimbursement Basis: AWP-10%, WAC +9.2%
  • Link for Provider application:

    This information is directly from Alabama Medicaid Department:

    AL has created an "abbreviated" out of state provider enrollment packet for pharmacies; this 4 page document can be found at our website:
    *Pharmacy provider numbers obtained utilizing this application will be effective August 29, 2005. AL Medicaid reimburses at lower of: AWP-10%, WAC+9.2%, FUL, DOJ, or State MAC; plus $5.40 dispensing fee for retail. For complete billing and reimbursement information, Chapter 27, Pharmacy Services, of our Billing Manual can be found on our website:
    *AL Medicaid pharmacy edits will continue for all recipients. AL Medicaid pharmacy edits include: Preferred Drug List, Four Brand Limit, Therapeutic Duplication, Maximum Units, Prior Authorization, etc. Information on all edits can be found on our website:
    *Requests for prior authorization must be certified as medically necessary by the physician and submitted to Health Information Designs (HID) for approval. Only HID can issue prior authorizations (PAs). HID may be contacted at 1-800-748-0130.

    Please do not hesitate to contact our Pharmacy Services at (334)242-5050 for more information. We thank all of you for your assistance during this time.

    Kelli D. Littlejohn, R.Ph.
    Director, Pharmacy Services
    Alabama Medicaid Agency
    (334) 353-4525

  • Contacts:
    Mary J. Terrebonne, Pharmacy Director, 1-225-342-1980; 800-437-9101;
    Contact: Carol, E-mail:
  • Website:
  • Restrictions: Plan covers a maximum 30 day supply or 100 unit doses, whichever is greater, with 5 refills for all Rx. Monthly limit of 8 Rx per participant.; provider status retroactive to August 27
  • Patient Cost Sharing: Copays range form $0.50-$3.00 based on cost of drug
  • Dispensing Fee: $4.45-$5.77
  • Ingredient Reimbursement Basis: EAC= AWP-15% for chain pharmacies, EAC= AWP-12% for independent pharmacies
  • Link for Provider application:

  • Contact:
    Judith Clark R.Ph, Pharmacy Director, 1-601-359-5253
    ACS is the claims processor for the state, and can be reached at 866-759-4108, E-mail:
  • Website:
    Restrictions: Plan covers a maximum 34 day supply or 100 unit doses, whichever is greater, with 5 refills for all Rx. Birth control pills may be dispensed in 3 month quantities. Monthly limit of 5 Rx per participant, 2 additional are allowed with Prior Authorization.; Provider status retroactive to August 29
  • Patient Cost Sharing: Copays range form $1.00-$3.00 based on cost of drug
  • Dispensing Fee: $3.91 for brand, $4.91 for generic
  • Ingredient Reimbursement Basis: EAC= AWP-12%; Generics AWP – 25%

  • Link for Provider application:
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