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 (CCW) is a program 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 assisted living facilities, and in adult foster care homes.
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 his/her adult child) and that individual receives compensation for providing care. Even spouses can be compensated for providing care under MIHC. 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, a waiting list to receive services exists. In Louisiana’s Medicaid language, this is referred to as 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 Medicaid waiver programs, and those individuals currently residing in nursing homes and who are able to return home with services via the Community Choices Waiver.
Eligibility Guidelines
The Community Choice Waiver is designed for residents of Louisiana aged 65 and over and for physically disabled individuals between the ages of 21 and 64. 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 long-term care Medicaid. As of 2022, an individual’s monthly income cannot exceed more than 300% of the SSI Federal Benefit Rate (FBR). This currently means that an individual cannot have a monthly income greater than $2,523. In addition, an individual cannot have countable resources (assets) in excess of $2,000.
For a married couple in which both spouses are applying for the Community Choices Waiver, the individual income limit is doubled. Therefore, the income limit is $5,046 / month. The asset limit is also slightly higher than is the individual limit at $3,000.
In the case where just one spouse of a married couple is an applicant, the applicant spouse can have up to $2,523 / month in income. The income of the non-applicant spouse is not considered towards the applicant spouse’s eligibility. For non-applicant spouses who have little to no income, there is a monthly maintenance needs allowance that enables applicant spouses to transfer income to their non-applicant spouses. As of 2022, this amount may be as much as $3,435/ month (effective January 2022 – December 2022). The couple’s assets, on the other hand, are considered jointly owned and are counted towards the applicant spouse’s eligibility. In addition to the $2,000 in assets the applicant spouse can retain, the non-applicant spouse can keep up to $137,400 of the couple’s assets. This is called a community spouse resource allowance. (Learn more here about how Medicaid counts jointly owned assets). Both the spousal income allowance and spousal resource allowance is intended to prevent the impoverishment of non-applicant spouses.
While the asset limit for individuals and couples might seem low, several assets are considered exempt, which means they aren’t counted towards Medicaid’s eligibility limit. One’s home, with an equity value up to $636,000, an automobile, household belongings, personal items, and burial trusts, are all considered exempt items.
However, one can still qualify for CCW if he or she exceeds the asset and /or income limit(s). For example, Louisiana Medicaid has a ‘Medically Needy’ clause where individuals who have very high medical bills relative to their income can still qualify. Individuals who have questions about the Medically Needy process, or who exceed the asset and / or income limit(s) should seek assistance qualifying for Medicaid before submitting their application paperwork. Learn more.
Benefits and Services
The CC 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. Some of these services, such as personal assistance services, are open to consumer direction. This means that the program participant can choose the caregiver of their choice, including friends and some family members. (Spouses and legal guardians, with the exception of MIHC, cannot be hired to provide care).
- 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, and grocery shopping
- 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)
*Applicants who choose Monitored In-Home Caregiving are not able to receive the following additional services while enrolled in this benefit: Adult day health care, meal delivery, and personal assistance services.
How to Apply / Learn More
One can read more about the Community Choices Waiver 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. Limited information is also found on the Louisiana Department of Health website.
Current Waiting Lists and Alternatives
Jan. 2022 Update: The waiting list for the Community Choices Waiver in Louisiana can be multiple years long, depending on how the case is prioritized. Some alternatives that needy seniors in Louisiana should consider are the Adult Day Care Waiver and the Long Term Personal Care Service Program. At this time, the Adult Day Care program has a 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.
