Healthy Louisiana (Medicaid) Long Term–Personal Care Services (LT-PCS) Program

Last updated: October 18, 2021

 

Overview of Louisiana’s Long Term-Personal Care Services Program

The Louisiana Long Term–Personal Care Services Program (LT-PCS) is intended for elderly or physically disabled adult residents who require assistance with their daily living activities in order to live at home. Intended to prevent and / or delay the need for nursing home admissions or allow persons to return home from a nursing home facility, program participants receive assistance with their activities of daily living (ADLs) and instrumental activities of daily living (IADLs). This includes bathing, dressing, walking, medication reminders, toileting, preparing meals, eating, laundry, and basic housecleaning.

While many home and community based services (HCBS) Medicaid programs allow program participants to self-direct their own care, specifically the ability to hire their own caregiver, the LT-PCS Program does not. Instead, program participants must receive personal care services via a licensed Medicaid provider. However, they can select their provider from a list of licensed providers.

 Louisiana seniors may also want to consider the Adult Day Health Care Waiver, through which adult day health care is provided. Persons can simultaneously be eligible for the Adult Day Health Care Waiver and the Long Term–Personal Care Services Program. Persons might also consider the Community Choices Waiver (CCW). CCW provides a variety of home and community based services, including personal assistance services and adult day health care.

Program beneficiaries can reside in their own home or the home of a loved one. It is unclear if a program participant can reside in an adult foster care home or an assisted living residence.

The LT-PCS Program is an entitlement, which means meeting the state’s Medicaid eligibility requirements guarantees one will receive benefits. Put differently, there is never a wait list to receive personal care services.

The Long Term–Personal Care Services Program is part of Louisiana’s regular state Medicaid program. Medicaid in Louisiana is called Healthy Louisiana.

 State Plan Medicaid versus Medicaid Waivers
While home and community based services (HCBS) can be provided via a Medicaid waiver or a state’s regular Medicaid plan, HCBS through Medicaid state plans are an entitlement. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid waivers require a program participant require the level of care provided in a nursing home, while state plan HCBS do not always require this level of care.

 

Benefits of the LT-PCS Program

The LT-PCS Program provides verbal reminders and hands on assistance with daily living activities. The specific services and amount of services provided are based on a functional evaluation. Follows is a list of activities with which one might receive help.

– Bathing / Grooming
– Dressing / Undressing
– Eating
– Household Tasks – laundry, grocery shopping, housecleaning
– Meal Preparation – includes cleaning up
– Medication Oversight – reminders, checking dosage, assistance opening bottle
– Mobility – includes walking or wheelchair use and repositioning in bed
– Toileting
– Transferring – i.e., moving from the bed to a chair or a wheelchair to standing
– Transportation Assistance – accompanying to medical appointments

 

Eligibility Requirements for LT-PCS Program

The LT-PCS Program is for LA state residents who are elderly (65+) or 21+ years old and disabled. Persons must currently reside in a nursing home and be able to relocate to the community if care assistance were provided OR anticipated to require nursing home admittance within 120 days OR have a main caregiver who is disabled or 70 years old or older. Persons must also be able to either independently direct their own care of have a representative do so on their behalf. Additional eligibility criteria are as follows and is relevant for seniors 65+ years of age.

 The American Council on Aging provides a quick and easy Medicaid eligibility test for LA seniors that require long term care. 

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 100% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. As of 2021, the income limit for a single applicant is $794 / month. Married couples, regardless of if one or both spouses are applicants, can have a monthly income up to $1,191.

 While many home and community based services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets, the Long Term–Personal Care Services Program does not. In contrast, Louisiana’s Adult Day Health Care Waiver and Community Choices Waiver do allow a non-applicant spouse a monthly maintenance needs allowance from his/her applicant spouse and a community spouse resource allowance.

Assets
In 2021, the asset limit is $2,000 for a single applicant. For married couples, the asset limit is slightly higher at $3,000. This hold true whether one or both spouses are applicants.

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.

While there is a 60-month look back rule in which Medicaid checks past asset transfers of those applying for nursing home Medicaid or home and community based services via a Medicaid waiver, it is thought that this is not relevant for the Long Term–Personal Care Services Program. In other words, the look back period is not applicable.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our spend down calculator

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for eligibility purposes, LA Medicaid / Healthy Louisiana considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a minor child (under 21) living in the home.
– The applicant has a blind or disabled child living in the home.

To learn more about the potential of Medicaid taking the home, click here.

 

Medical Criteria: Functional Need

An applicant must require a nursing facility level of care (NFLOC). For the LT-PCS Program, the Level of Care Eligibility Tool (LOCET) determines if this level of care need is met. There are several different “pathways” to meeting the level of care provided in a nursing home. A common pathway is a need for assistance with activities of daily living (i.e., transferring from the bed to a chair, mobility, eating, toileting, personal hygiene, bathing). Another pathway, which is relevant to some persons with Alzheimer’s disease or a related dementia, is a cognitive performance pathway. Via this pathway, short term memory, daily decision making capability, and ability to communicate are assessed. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

Regardless of one’s pathway to NFLOC eligibility, an applicant must require assistance with a minimum of one activity of daily living.

 For more information about long-term care Medicaid in Louisiana, click here.

 

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 / Healthy Louisiana. 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.

Louisiana has a Medically Needy Spend-Down Program for applicants who have high medical expenses relative to their income. Via this program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit.

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 / Healthy Louisiana 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’s Long Term-Personal Care Services Program

Before You Apply

Prior to submitting an application for the LT-PCS Program, applicants need to ensure they meet the eligibility criteria for LA Medicaid / Healthy Louisiana. 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 need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, proof of income, previous bank statements, 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.

 

Application Process

To apply for the Long Term–Personal Care Services Program, persons should contact Louisiana Options in Long Term Care at 877-456-1146. Persons can also contact the Medicaid regional office in their area. Contact information can be found here.

For additional information about the Long Term–Personal Care Services Program, click here and here. Persons can also contact the Office of Aging and Adult Services Helpline at 866-758-5035. The Louisiana Office of Aging and Adult Services (OAAS) within the Department of Health operates the Long Term–Personal Care Services Program.

 

Approval Process & Timing

The Medicaid / Healthy Louisiana 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. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further.

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