Overview of Louisiana Medicaid Community Choices Waiver
The Louisiana Community Choices Waiver, abbreviated as CCW or CC Waiver, provides home and community-based services (HCBS) for seniors and adults with disabilities (adult on-set) who are at risk of nursing home admission. Intended to assist these persons in remaining at home or in the community, a variety of long-term services and supports are available. These include personal care assistance, home modifications, respite care, adult day care, home meal delivery, and transitional services for nursing home residents who are able to return to the community with support. Monitored in-home caregiving (MIHC), which can be thought of similarly to adult foster care, is another available support. With MIHC, a program participant lives in a private home with a primary caregiver and receives care assistance. The caregiver, who can be a friend or relative, including an adult child or spouse, is paid to provide care.
There is also flexibility of providers for persons receiving personal assistance services, as this type of care may be consumer directed. Rather than receive services by a licensed care provider, a program participant can hire their own “caregiver”. As with MIHC, relatives, such as a grown child or spouse can be hired. A financial management services agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.
CWW services can be received in one’s home, the home of a loved one, an assisted living residence, or an adult foster care home. A program participant residing in assisted living or an adult foster care home cannot receive CWW services, such as personal care assistance, if they are already receiving such services in these settings.
CWW is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, there are a limited number of participant enrollment slots, and when these slots are full, a waiting list for program participation forms. Specific to LA, this is called a Request for Services Registry.
Louisiana’s Community Choices Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. CCW replaced the Elderly and Disabled Adult Waiver (EDA).
Benefits of the Community Choices Waiver
Follows is a list of long-term services and supports available via the Community Choices Waiver. An individual care plan determines which services and supports a program participant receives.
– Adult Day Health Care – daytime supervision and care in a community group setting
– Assistive Devices – includes personal emergency response systems, medication management devices, health status monitoring
– Assistive Technology
– Care Coordination / Case Management
– Home Delivered Meals – includes medically tailored meals and nutritional counseling
– Home Modifications – i.e., wheelchair ramps, stair lifts, roll-in showers, pedestal sinks
– Housing Stabilization Services
– Housing Transition / Crisis Intervention Services
– Medical Supplies
– Monitored In-Home Caregiving (MIHC) Services – assistance with daily activities is provided by a live-in caregiver
– Nursing Services
– Personal Assistance Services – assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) – i.e., bathing, dressing, mobility, preparing meals, eating, light housecleaning, shopping for essentials
– Skilled Maintenance Therapy Services – i.e., physical, occupational, speech and language
– Respite Care (called Caregiver Temporary Support Service) – short-term, in-home and out-of-home care to relieve a primary caregiver
– Transition Intensive Support Coordination – for persons moving from a nursing home back into the community
– Transition Services – coverage of onetime expenses (i.e., security deposit, utility set up fees, essential home furnishings) to assist one in relocating to the community from a nursing home
Program participants who receive Monitored In-Home Caregiving Services cannot receive adult day health care, home delivered meals, or personal assistance services.
While services may be provided in an assisted living residences and adult foster care homes, the cost of room and board is not covered by the CC Waiver.
Eligibility Requirements for Louisiana Medicaid Community Choices Waiver
CCW is for Louisiana residents who are elderly (aged 65+) or younger (between 21 and 64 years old) if physically disabled and at risk of nursing home placement. Persons with disabilities who enroll prior to turning 65 can continue to receive Waiver services upon turning 65. Additional eligibility criteria for persons aged 65+ are as follows:
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases annually in January. In 2024, an applicant, regardless of marital status, can have a monthly income up to $2,829. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,829 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance. In 2024, the maximum amount that can be transferred is $3,853.50 / month and is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a Spousal Income Allowance.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA). In 2024, the CSRA allows the non-applicant spouse to retain up to $154,140.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that LA Medicaid will take it. Fortunately, for eligibility purposes, Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “Intent” to Return home, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse who lives in the home.
– The applicant has a minor child (under 21) who lives in the home.
– The applicant has a blind or disabled child who lives in the home.
While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC). For CCW, the interRAI Home Care Assessment tool is used to make this determination. There are several factors that are considered when determining this level of care need. This includes an applicant’s ability / inability to independently complete their Activities of Daily Living (ADLs) (i.e., transferring from the bed to a chair, mobility, eating, toileting), unstable medical conditions, the need for rehabilitation therapies, and cognitive issues, such as short-term memory deficiencies and difficulties making day-to-day decisions, which are commonly seen in persons with Alzheimer’s disease or a related dementia. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for LA Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Excess Income
Louisiana allows “Waiver Spend-down” for Community Choices Waiver applicants who have income over Medicaid’s income limit. This is also called the Spend-down Medically Needy Home and Community Based Services Program and allows persons to spend their “excess” income on medical expenses to become income-eligible. Allowable expenses might include health care premiums, such as Medicare Part B, and medical care expenses not covered by a third party. Furthermore, the anticipated cost for services provided via CCW can be considered a medical expense. To qualify via this pathway, one’s medical expenses must be greater than their “excess” income. Program participants are permitted to keep a Personal Needs Allowance of $2,829 / month (in 2024).
Excess Assets
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons can also “spend down” assets on home improvements (i.e., updating plumbing, replacing a water heater), home modifications (i.e., adding a first floor bedroom, addition of grab bars), and replacing an older car with a newer one. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in the state of LA to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. While there are a variety of planning strategies, some, such as Medicaid Asset Protection Trusts, do violate Medicaid’s 60-month Look-Back Rule. Therefore, they should be implemented well in advance of the need for long-term care. However, there are some workarounds, such as Modern Half-a-Loaf, and Medicaid Planners are aware of them. For all of these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for Louisiana Medicaid Community Choices Waiver
Before You Apply
Prior to submitting an application for the Community Choices Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
The Community Choices Waiver is approved for a maximum of approximately 5,305 beneficiaries each year. Currently, a waiting list exists, which dates back to January of 2023. It is formally called the Community Choices Waiver Request for Services Registry. An applicant’s access to a participant slot is based on priority, which is given in the following order: Persons with a referral from protective services who would otherwise require nursing home placement due to abuse or neglect, persons with a diagnosis of Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease), persons who are living in State of Louisiana Permanent Supportive Housing, persons in Medicaid-funded nursing homes, persons who are not currently receiving Medicaid-funded long-term care services, and all other persons by request date. Additionally, there are up to 300 slots reserved for persons who require expedited CCW services under specific circumstances.
Application Process
To apply for the Community Choices Waiver, applicants should call Louisiana Options in Long Term Care at 877-456-1146. An applicant’s name will be added to the Community Choices Waiver Request for Services Registry.
Learn more about the Community Choices Waiver here and here. Questions can be directed to Louisiana Options in Long Term Care at 877-456-1146.
The Bureau of Health Services Financing (BHSF) administers the Community Choices Waiver and the Office of Aging and Adult Services (OAAS) operates it. BHSF and OASS are within the Louisiana Department of Health (LDH).
Approval Process & Timing
The Louisiana Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waiting list exists, approved applicants may spend many years waiting to receive benefits.