Waiver Description
This Louisiana Adult Day Health Care (ADHC) Medicaid waiver is designed to help the elderly remain living at home or to help families care for a loved one in their home, instead of placing the individual in a nursing home facility. It does this by providing adult day health care services during daytime hours and, at some locations, evening hours and weekends. ADHC programs may have an affiliation with an assisted living home, a nursing home, or may be a separate entity of its own.
Adult day care offers a variety of personal care, social, and recreational activities for the elderly, as well as meal services during normal business hours in a group setting. This waiver program is designed to enable the primary caregiver or family member to continue to work and to care for his or her loved one in the evenings and on weekends. Often, transportation for the eligible individual is provided by the adult day care center if the individual lives within a reasonable distance from the center.
Participation in this program does not preclude individuals from receiving other assistance from the state of Louisiana. Residents might also be interested in the Community Choices Waiver or LT-PCS.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
General Requirements
To be eligible for the ADHC waiver, an applicant must reside in Louisiana. This waiver also considers the applicant’s age and functional ability.
Candidates must be at least 65 years of age OR be between the ages of 22 and 64 and be physically disabled. Persons also must require nursing-facility level care. But to receive services through this wavier, they cannot live in a nursing home for an indefinite period. ADHC participants must also be financially qualified for Medicaid.
Financial Requirements
Income Limits
The monthly income limit for a single applicant for 2023 is $2,742 per month.
For couples, with both spouses applying for the ADHC waiver, their combined income cannot exceed $5,484 a month. When only one spouse of a married couple is applying, the non-applicant spouse’s income is not counted toward the applicant spouse’s income limit. However, if the non-applicant spouse has no income or very little income, a portion of the applicant spouse’s income can be transferred to the non-applicant spouse. As of 2023, if the non-applicant spouse has monthly income below $3,715.50 (referred to as a Minimum Monthly Maintenance Needs Allowance), some income can be shifted to the non-applicant spouse from the applicant spouse as a living spousal allowance.
Asset Limits
Single applicants must hold less than $2,000 in countable assets. A married couple with both spouses applying can have assets valued up to $3,000. When only one spouse is applying, the non-applicant spouse can have up to $148,620 in assets. This is called the Community Spouse Resource Allowance.
Several assets are not counted toward the limit, including the home, which must have an equity value under $688,000, household items, personal belongings, and one vehicle.
Over the Financial Limits?
Applicants with finances over these limits should consider working with a Medicaid planning professional. Persons in these situations still may be eligible for Medicaid, but just require financial expertise to help them allocate their income and resources appropriately.
Learn more about Medicaid planning here.
Benefits and Services
All eligible applicants are provided with adult day care and case management services. Some individuals can also be approved to receive the following services and supports:
- Support coordination / Case management
- Transitional services – moving from a nursing home back into the community
- Health education
- Nursing services
- Dietary services – meals and snacks
- Exercise programs
- Medication supervision and administration
- Personal care – assistance with daily living activities, such as hygiene, mobility, and toiletry
- Other social services
- Transportation between home and the adult day care center
How to Apply / Learn More
This program is available statewide across Louisiana. To apply or determine availability in your local area, call Louisiana Options in Long Term Care at 877-456-1146. Alternatively, one can consult with their local area agency on aging.
Priority admission is given to those who are being discharged from a nursing home or hospital. If your loved one is currently in a skilled nursing rehabilitation center following a hospital stay and you are considering employing this benefits program, you should apply before they are released.
More information on the Adult Day Health Care waiver can be found on this Fact Sheet and on the Louisiana Department of Health’s website.
