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
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.
Did You Know? Approximately 90% of adult day care centers offer cognitive stimulation programs and almost 80% provide memory training.
Eligibility Guidelines
To be eligible for the ADHC waiver, an applicant must reside in Louisiana. This waiver also considers the applicant’s age, functional ability, and financial resources.
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.
The Rules for Individuals
The monthly income limit for a single applicant for 2022 is $2,523 per month. This is a gross income limit, so for individuals who may be close to this number, be sure to include all income and income deductions to correctly assess eligibility.
Single applicants must hold less than $2,000 in countable assets, excluding their home, which must have an equity value under $636,000, household items, personal belongings, and one vehicle.
The Rules for Married Couple with Two Applicants
When both spouses are applying for the ADHC waiver, their combined incomes cannot exceed $5,046 a month. Their combined assets can be valued up to $3,000.
The Rules for Married Couples with One Applicant
In this situation, the single applicant income limit of $2,523 applies to all income in the name of the spouse applying for benefits. Said another way, the non-applicant spouse’s income is not counted towards 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 2022, if the non-applicant spouse has monthly income below $3,435 (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.
Unlike income, the assets of the couple are considered jointly owned. Learn more here. The applicant spouse is allowed to retain up to $2,000 in assets, and the non-applicant spouse can have up to $137,400 in assets. This is called the community spouse resource allowance and does not include the value of their primary home real estate.
Persons Exceeding these Limits
Those over the limits, or those persons unsure if they qualify financially, should consider consulting a Medicaid planning professional prior to applying. Read more 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 1-877-456-1146. Alternatively, one can consult with his/her local area agency on aging or download the Fact Sheet for more information. Limited information is also available on the Louisiana Department of Health website.
The state maintains a registry of those people who are interested in this waiver once a spot opens. Currently, spending caps mean that the program is not able to meet the demand for support for aging services.
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.
