Louisiana Community Choices Waiver

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

The Louisiana Community Choices Waiver is a relatively new program launched in 2011 for elderly and / or disabled Louisiana residents. This program, which replaced the Elderly and Disabled Adult Waiver, provides a wide range of services and support to assist elderly state residents in maintaining their independence. In other words, it helps to prevent institutionalization in nursing homes by providing support at home.

In addition to in-home support services, this waiver offers a unique benefit called Monitored In-Home Caregiving (MIHC), which can loosely be compared to adult foster care. Under MIHC, a family member or friend can move in to the care recipient's home and get paid to provide care. The alternative option exists as well, where the elderly individual moves into a friend or younger family member's home (such as their adult children) and those persons receive compensation for providing care. However, it’s important to note that the caregiver must adhere to the rules set forth by the Department of Health and Hospitals (DHH) and be approved as a MIHC service provider.

Unfortunately, despite being a new program, a waiting list to receive services exists. In Louisiana’s Medicaid language, this is referred to a Request for Services Registry (RFSR). A complicated prioritization process exists for the wait list. It is not simply ‘first come, first serve.’ Persons experiencing abuse or neglect receive the highest priority. Other conditions that increase priority include a diagnosis of Lou Gehrig's disease (Amyotrophic Lateral Sclerosis), a lack of benefits from other Louisiana waiver programs, and those individuals currently residing in nursing homes and who are able to return home.

 

Eligibility Guidelines

The Community Choice Waiver is designed for residents of Louisiana aged 65 and over and for physically disabled individuals over the age of 21. Waiver participants must require the level of care provided in a nursing home, but choose to receive that care outside of a nursing home environment.

In addition to the medical eligibility requirements, individuals must be financially eligible to receive Medicaid. As of 2017, an individual’s monthly income cannot exceed more than 300% of the Federal Benefit Rate. This currently means that an individual cannot have a monthly income more than $2,205. In addition, an individual cannot have countable resources more than $2,000. A married couple applying together can have up twice the individual monthly gross income and up to $3000 in savings.

One can still qualify if he or she exceeds these limits. For example, Louisiana Medicaid has a ‘Medically Needy’ clause where individuals who very high medical bills relative to their income can qualify. Individuals who have questions about the Medically Needy process or who exceed the asset or income limits should seek assistance qualifying for Medicaid prior to submitting their application paperwork. Learn more.

 

Benefits and Services

This waiver provides for a wide variety of services and support for the elderly and disabled.  Follows is a list of possible services; actual services are participant specific.  It was unclear at the time of writing whether any of these services were open to consumer direction.  

  • Adult day health care / Adult day care
  • Assistive technology – includes personal emergency response systems
  • Case management
  • Durable medical equipment
  • Disposable medical supplies
  • Home modifications to increase an individual's independence –ramps, lifts, roll shower, widening of doorways, etc. 
  • Monitored In-Home Caregiving
  • Personal assistance with the activities of daily living, such as dressing, toileting, mobility, and bathing
  • Personal assistance with instrumental activities of daily living, such as meal preparation, light housecleaning, laundry, grocery shopping, etc. 
  • Meal delivery
  • Physical, occupational, and speech therapy
  • Respite care – In-home and out-of-home
  • Supports and services to assist individuals moving out of nursing homes
  • Skilled nursing (on a temporary basis)

 

How to Apply / Learn More

One can read more about the program or begin the application process by downloading the PDF or by calling the Louisiana Options in Long Term Care Help Line at 1-877-456-1146. 

Current Waiting Lists and Alternatives
March 2017 Update: the waiting list for the Community Choices Waiver in Louisiana can be multiple years long, depending on how the case is prioritized. The oldest cases on the list go back to 2009. Some alternatives that needy seniors in Louisiana should consider are the Adult Day Care Waiver and the Long Term Personal Care Service Program. The Adult Day Care program has only a 14-month waiting list, while the Long Term Personal Care Services Program does not have a waiting list. Still another option is the Permanent Supportive Housing program, which offers dedicated units for frail elderly persons.