Page Reviewed / Updated - Jan. 2019
Louisiana Medicaid helps seniors by providing personal / custodial care services to assist them with their Activities of Daily Living (ADLs), such as bathing, grooming, transferring, and mobility through the Long Term Personal Care Services (LT-PCS) program. Unlike the Louisiana Home and Community Based Waivers, this program does not have a waiting list, as it is part of the state Medicaid plan. (The state Medicaid program is an entitlement, meaning anyone who is eligible is able to receive services. On the other hand, Medicaid Waivers are not entitlement programs, which means there may be waitlists to receive services).
In addition to assistance with ADLs, services included are assistance with what are referred to as the Instrumental Activities of Daily Living (IADLs), such as food preparation, medication reminders, and transportation. The program is designed to allow seniors to remain living in their homes or to "age in place," even though they are qualified to receive nursing home care. Medical / skilled care services are not included in this program, nor is around the clock care.
To be eligible for the LT-PCS program, an individual must be a resident of Louisiana. This program is intended for disabled individuals 21 years of age and older that are qualified for nursing home care. Make note, applicants 65 years old and older need not be disabled. In some cases, qualified applicants must have a doctor’s prescription and the services must be medically necessary. That being said, all applicants must need assistance with a minimum of one daily living activity, such as bathing, grooming, dressing, or eating. Additionally, applicants must currently be residing in a nursing home, be expected to require nursing home admission sometime in the next 4 months, or have a primary caregiver who is either disabled or is a minimum of 70 years old.
Eligible applicants must be willing to live at home, instead of in a nursing home, as well as have the capacity to direct their care. A family representative may be assigned to assist the senior with care management.
In addition to the functional requirements, candidates must meet the financial eligibility criteria for Louisiana Medicaid. In 2019, the monthly income limit for seniors is equivalent to the current SSI limit, which means an individual cannot receive an excess of $771 per month. For married applicants (with both spouses applying), the income limit is $1,157. There is also an asset limit, which as of 2019, is $2,000 for a single applicant and $3,000 for married applicants. However, there are several ways individuals whose finances exceed these limits can still qualify.
Married couples have the flexibility to adjust their finances if one spouse is applying for Medicaid Personal Care Services and the other is not. Under these circumstances, only income in the applicant’s name is counted. Said another way, the non-applicant’s income is disregarded. In addition, the applicant spouse can transfer a portion of his/her income to the non-applicant spouse, also called the community spouse, if he/she does not have sufficient income from which to live. This is called the monthly maintenance needs allowance, and as of 2019, allows the applicant spouse to transfer a monthly maximum of $3,160.50 to his/her non-applicant spouse.
A similar protection exists for the couples’ countable assets. (Assets for married couples are considered jointly owned. Learn more here.) In 2019, the non-applicant spouse is allowed up to $126,420 in countable assets (this is known as the community spouse resource allowance), while the applicant can have $2,000, for a total maximum of $128,420 in countable resources.
Becoming Financially Eligible
Louisiana has a Medically Needy Program (MNP), which can be thought of as similar to a deductible. In basic terms, persons who have income in excess of the limit can “spend down” their income to meet the income limit. Commonly called a spend-down program, it can be thought of as similar to a deductible. Excess income can only be spent on specific expenses, such as medical and care costs.
Louisiana residents who cannot afford their cost of care, but still cannot qualify for financial reasons, might consider working with a Medicaid planner. These professionals help families to qualify by re-allocating their resources so they become exempt income streams, such as Medicaid compliant annuity. (An annuity, in simple terms, is the investment of a large amount of money that produces monthly income for either life or a set period of time.)
Similarly, assets can be converted from countable to exempt (non-countable). Examples include modifying a home to allow aging in place and paying off debt, such as one's mortgage. In addition, LA Medicaid allows certain exemptions for things like the individual’s primary home (valued up to $585,000), burial plots, and final expense insurance.
Three points worth making about these services are that they only apply to the program participant. If that person resides with another non-Medicaid house mate then services, such as housekeeping and meal preparation are only for the program participant. Second, while medical services are not provided under this waiver, participants can receive those services under other Medicaid programs concurrently. Lastly, a limit of 32 hours per week can be provided regardless of need.
This program is available in all Louisiana counties and is administered by the Office of Aging and Adult Services (OAAS). One can learn more from their local Louisiana Area Agency on Aging or by calling Louisiana Options in Long Term Care at 1-877-456-1146. A brief article about this program is available here and a contact person is available at (225) 342-5691. Additional information can be found here.