Louisiana Medicaid Definition
In Louisiana, Medicaid is administered by the Louisiana Department of Health. It is also called Healthy Louisiana and formerly called Bayou Health.
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, this page is focused strictly on Medicaid eligibility for elderly Louisiana residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Louisiana seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as differing benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Louisiana offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Limited number of participants. Therefore, wait lists may exist. Provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (anyone who meets the requirements will receive assistance) and is provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Louisiana Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT: if one does not meet all the criteria below, it does not mean they are not eligible or cannot become eligible for Medicaid. More.
|2018 Louisiana Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Nursing Home||$4,500 / month||$3,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Nursing Home||$4,500 / month||$3,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$750 / month||$2,000||None||$1,125/ month||$3,000||None||$750 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include cash from family and friends, Veteran’s benefits, employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, just the income of the applicant is counted. Said another way, the income of the non-applicant spouse is not counted. There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. (As of July 2018, this figure falls between $2,057.50 / month and $3,090 / month). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live. This also effectively lowers the income of the applicant spouse for eligibility purposes.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, life insurance policies (total face value limit of $10,000, as of 2018), and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse, also referred to as the well spouse) can keep up to a maximum of $123,600 of the couple’s joint assets, as the chart indicates above. This, in Medicaid terminology, is called the Community Spouse Resource Allowance (CSRA) and is intended to prevent the community spouse from becoming impoverished.
One should be aware that Louisiana has a Medicaid Look-Back Period, which is a period of 60 months that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. To be clear, this includes gifts to family and friends. If one is found to be in violation of the look-back period, a penalty period will be established and one will be ineligible for Medicaid during this timeframe.
Qualifying When Over the Limits
For Louisiana elderly residents (65 and over), who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In Louisiana, there is a Medically Needy Program (MNP), also referred to as a “Spend-Down” program, which is specifically intended for those that have income over the Medicaid limit. In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit if they have high medical bills in relation to their monthly income. The way this program works is one’s “excess income,” (the amount that is over the Medicaid limit) is used to cover medical bills. (This can be thought of similarly to a deductible). Once one has spent down their excess income for the “spend-down” period, the applicant will receive Medicaid benefits for the remainder of the spend-down period. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the Medically Needy Program cannot assist one in “spending down” extra assets.
However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications. This might include the addition of wheelchair ramps, stair lifts, widening the doorways for wheelchair access, or adding a first floor bedroom and / or bathroom. One can also “spend down” assets by prepaying funeral / burial expenses and paying off debt, such as one’s mortgage. As mentioned previously, when spending down assets, it’s important that one does not give away assets or sell them way under market value. This is because in Louisiana, Medicaid has a “Look-Back” period of 5 years, and if one is in violation, a period of Medicaid ineligibility may result.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Louisiana Medicaid Programs
1) Adult Day Care Waiver – This waiver, also referred to as the Adult Day Health Care (ADHC) Waiver, provides adult day care for elderly and disabled Louisiana residents to prevent and / or delay institutionalization.
2) LT-PCS Waiver – The Long Term – Personal Care Services (LT-PCS) Program is an entitlement program through the state Medicaid plan. Assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as bathing, grooming, mobility, eating, laundry, and shopping for essentials is provided in one’s home.
3) Community Choices Waiver (CC) – This waiver is intended for those that would require nursing home placement if not for the services available via this program. Benefits, such as durable medical equipment, adult day care, temporary skilled nursing, and assistive technology is available to those residing at home, in assisted living, or adult foster care.