Louisiana Medicaid / Healthy Louisiana Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Louisiana, Medicaid is called Healthy Louisiana. This article focuses on Louisiana Medicaid Long Term Care for seniors, which will pay for care in a nursing home, beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.

Louisiana Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Louisiana Medicaid, which is called Healthy Louisiana, will cover the cost of long term care in a nursing home for eligible Louisiana residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Skilled nursing care
• Physician’s visits
• Prescription medication
• Medication management
• Mental health counseling
• Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Louisiana Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $40/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Louisiana Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help Healthy Louisiana (Louisiana Medicaid) recipients who require a Nursing Facility Level of Care remain, or return to, living in the community instead of living in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Louisiana residents who live in their home, the home of a family member, an adult foster care home or an assisted living residence. the home of a loved one or an assisted living personal care home. While Louisiana’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.

The HCBS Waivers relevant to Louisiana seniors are the Community Choices Waiver and the Adult Day Health Care Waiver.

1. Community Choices Waiver (CCW)
Louisiana’s Community Choices Waiver (CCW) provides long-term care benefits to Louisiana seniors who require a Nursing Facility Level of Care and live in their own home, the home of a loved one, an assisted living residence or an adult foster care home, but it will not cover room and board costs. If a senior is already receiving some long-term care benefits in assisted living or adult foster care, the CCW will not cover or duplicate those services.

Community Choices Waiver (CCW) benefits include nursing services, skilled therapy services (physical, occupational, speech), adult day care, home modifications, meal delivery, housekeeping services, personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Monitored In-Home Caregiving (MIHC) services. With MIHC, the CCW beneficiary lives in a private home with a paid caregiver, who can be a friend or a relative, including a spouse. The CCW beneficiary can also self-direct their care by selecting a caregiver of their choice to deliver some of the other CCW benefits, such as personal care assistance or housekeeping, and this person can also be a relative, but they can not be a spouse.

Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. Instead, there are a limited number of enrollment spots for each waiver program, and once those spots are full, additional eligible applicants are placed on a waitlist. The CCW had about 5,300 enrollment spots per year as of 2022.

2. Adult Day Health Care (ADHC) Waiver
Louisiana’s Adult Day Health Care (ADHC) Waiver, which is also called the Adult Day Care Waiver, provides day-time supervision and healthcare for Louisiana seniors who require a Nursing Facility Level of Care and live in their own home or the home of a loved one. The Minimum Data Set for Home Care (MDS-HC) is used to determine if ADHC Waiver applicants do require a Nursing Facility Level of Care.

In addition to supervision, ADHC Waiver facilities provide nursing services, medication management, assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and, in some situations, transportation to and from and the facility. Adult day health care centers may be a standalone facility or affiliated with a senior center, nursing home or assisted living residence.

The ADHC Waiver also provides transitional services for seniors living in Louisiana nursing homes who wish to move back to the community. This benefit will cover expenses like a security deposit and necessary furnishings.

Louisiana’s Adult Day Health Care (ADHC) Waiver had about 900 enrollment spots per year as of 2022. Once those spots are full, other eligible applicants will be placed on a waitlist.

Aged, Blind, and Disabled Medicaid

Louisiana’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to Louisiana residents with limited financial resources who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

Louisiana ABD Medicaid recipients can receive long-term care benefits through the state’s Long Term – Personal Care Services Program and the Program of All-Inclusive Care for the Elderly.

1. Long Term – Personal Care Services (LT-PCS) Program
Louisiana’s Long Term – Personal Care Services (LT-PCS) Program provides long-term care services and supports to Louisiana ABD Medicaid recipients who live in their own home or the home of a loved one and require a Nursing Facility Level of Care. Louisiana uses the Level of Care Eligibility Tool to determine if LT-PCS applicants do require a Nursing Facility Level of Care.

The benefit of the Long Term – Personal Care Services (LT-PCS) Program is assistance with Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, cooking, cleaning, medication management, transferring and transportation).

The LT-PCS Program, like ABD Medicaid itself, is an entitlement. This means that all eligible applicants are guaranteed by law to receive LT-PCS benefits.

2. Program of All-Inclusive Care for the Elderly (PACE)
Louisiana residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Louisiana’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Louisiana PACE programs are located in New Orleans (PACE Greater New Orleans) and Baton Rouge (PACE Baton Rouge). To learn more about PACE, click here.

Eligibility Criteria For Louisiana Medicaid Long Term Care Programs

To be eligible for Healthy Louisiana (Louisiana Medicaid), a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Louisiana Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Louisiana residents have to meet an asset limit and an income limit in order to be financially eligible for Louisiana Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Louisiana Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Louisiana Nursing Home Medicaid beneficiaries must give most of their income to the state to help cover the cost of nursing home care. They are only allowed to keep $38/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Healthy Louisiana is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for Louisiana Nursing Home Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if the applicant needs this level of care, the state will assess their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as their cognitive ability.

Louisiana Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Louisiana residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Louisiana is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2023 income limit for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Louisiana is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers in Louisiana is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if the applicant needs this level of care, the state will assess their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as their cognitive ability.

Louisiana Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Louisiana residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid in Louisiana. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for ABD Medicaid in Louisiana for a single applicant is $943/ month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for ABD Medicaid in Louisiana is $3,000 combined between the two applicants/spouses, and the income limit is $1,415/month combined. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.

Functional Requirements
The only functional requirement for Aged, Blind, and Disabled (ABD) Medicaid through Healthy Louisiana is being aged (65 or over), blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, the state will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of services the applicant needs and the state will cover.

How Louisiana Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

• If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
• If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
• If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Louisiana Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Louisiana and how you can protect your home from it, click here.

Applying For Louisiana Medicaid Long Term Care Programs

The first step in applying for Healthy Louisiana (Louisiana Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Healthy Louisiana coverage when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Healthy Louisiana applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Louisiana residents can apply online through Louisiana Medicaid’s Self Service Portal. They can also apply in person at a Medicaid Application Center, or get help from their local Area Agency on Aging office.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Choosing a Louisiana Medicaid Nursing Home

After being approved for nursing home coverage through Healthy Louisiana (Louisiana Medicaid), seniors have to choose which Medicaid-accepting nursing best fits their circumstances. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available beds. Finding a nursing home that meets all of your needs can be a chore, especially if you’re looking in a specific area.

Louisiana has about 250 nursing homes that accept Medicaid. They are spread out across the state, with many small communities having their own nursing home, although there are clusters around the major cities. There are roughly 30 nursing homes that accept Medicaid within 25 miles of Baton Rouge, and about 30 more within that range of Lafayette. In the northwest corner of the state, there are approximately 25 facilities in the Shreveport and Bossier City areas. And there are about 25 nursing homes in and around the state’s biggest city, New Orleans.

Residents in some Louisiana communities may regularly cross the state border for personal or business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, a Healthy Louisiana beneficiary will not be covered in a nursing home in Vicksburg, Mississippi, or Port Arthur, Texas, even if facilities in those cities might be convenient or well-suited for the Healthy Louisiana beneficiary.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in Louisiana.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS shows that nursing homes in Louisiana were well above average in terms of health inspections and fire safety. Louisiana nursing homes averaged 15.6 health deficiencies that led to citations from 2019-2022, and the national average was 25.7. The gap is even greater when it comes to fire safety deficiencies during that same three-year window: 3.2 vs. 13.5. The data also showed that just 1.6% of residents in Louisiana nursing homes had depressive symptoms, which is much better than the national average of 8.1%.