Louisiana Medicaid Definition
In Louisiana, Medicaid is administered by the Louisiana Department of Health. The Medicaid program is also called Healthy Louisiana and formerly was called Bayou Health.
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, the focus here is Medicaid eligibility for elderly Louisiana residents, aged 65 and over. Specifically, long term care is covered. This includes care provided in one’s home, an adult foster care home, an assisted living residence, or a nursing home 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 varying financial and medical (functional) eligibility requirements, as well as 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 – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; There are a limited number of participant enrollment slots and wait lists may exist. Intended to delay and prevent nursing home admissions, services are provided at home, adult day care, adult foster care, or in assisted living. More about Medicaid waivers.
3) Regular Medicaid / Aged Blind and Disabled – This is an entitlement program; Anyone who meets the requirements will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available
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, one can take the Medicaid Eligibility Test. IMPORTANT: If one does not meet all the criteria below, it does not mean they are ineligible or cannot become eligible for Medicaid. More.
|2022 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||$2,523 / month*||$2,000||Nursing Home||$5,046 / month*||$3,000||Nursing Home||$2,523 / month
for the applicant*
|$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month||$2,000||Nursing Home||$5,046 / month||$3,000||Nursing Home||$2,523 / month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs|
What Defines “Income”
Any income that a Medicaid applicant receives is counted. This 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. Holocaust restitution payments and Covid-19 stimulus checks do not count as income. Therefore, they do not impact Medicaid eligibility.
When only one spouse of a married couple applies for nursing home Medicaid or a Medicaid waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse does not impact their spouse’s Medicaid eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the applicant spouse to prevent spousal impoverishment. In 2022, the MMMNA in LA is $3,435 / month. If the non-applicant spouse has monthly income under this amount, income can be transferred from the applicant spouse to the non-applicant spouse, bringing their income up to this level. A non-applicant spouse who already has a monthly income of $3,435 or more is not entitled to a MMMNA / spousal income allowance.
The MMMNA also effectively lowers the income of the applicant spouse for eligibility purposes. Click here to learn more about how Medicaid counts income.
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. Medicaid also considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, life insurance policies (combined face value limit of $10,000), and generally one’s primary home. For the home to be exempt, the Medicaid applicant must live in it or have “intent to return” and have a home equity interest under $636,000 (in 2022). Equity interest is the home value, minus any outstanding debt, in which the Medicaid applicant owns. If a non-applicant spouse lives in the home, the above rules do not apply and the home is automatically exempt. There is no home equity limit for seniors applying for regular Medicaid.
All assets of a married couple are considered jointly owned and impact the Medicaid eligibility of the applicant spouse. This is true regardless of the Medicaid program for which a senior applies. However, the non-applicant spouse of a Medicaid nursing home or Waiver applicant is permitted to retain a larger portion of the couple’s assets. This is called a Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished. In 2022, the non-applicant spouse can keep up to $137,400 of the couple’s assets as a resource allowance.
Louisiana has a 60-month Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During which, Medicaid checks to ensure no assets were sold or given away under fair market value. This includes gifts to friends and family, as well as asset transfers one’s spouse made. Violating the look-back period results in a penalty period of Medicaid ineligibility.
Qualifying When Over the Limits
Louisiana elderly residents (65 and over) who do not meet the eligibility requirements above can qualify for Medicaid in other ways.
1) Medically Needy Pathway – Louisiana has a Medically Needy Program (MNP), also called a “Spend-Down” program, for seniors who have income over the Medicaid limit. This program allows persons with high medical bills in relation to their monthly income to become income-eligible by spending “excess” income on medical expenses. LA sets a medically needy income eligibility standard (MNIES), which is the level to which one must “spend down” their income. The MNIES is very low, and in 2022, is $100 / month for an individual and $192 / month for a couple living in an urban area (East Baton Rouge, Jefferson, Orleans, and St. Bernard Parishes). In rural areas, it is even lower at $92 / month for an applicant and $167 / month for couples. The amount one must “spend down” is the difference between their monthly income and the MNIES. This can be thought of as a deductible. In LA, the “spend down” is calculated for a 3-month period. Once it has been met, one will receive Medicaid benefits for the remainder of the period. The medically needy asset limit is $2,000 for an individual and $3,000 for a couple. Learn more about the medically needy pathway.
2) Asset Spend Down – Applicants who have assets over Medicaid’s limit can become asset eligible by “spending down” assets on non-countable ones. One way to do this is to make home modifications, such as adding wheelchair ramps or stair lifts, widening doorways for wheelchair access, or adding a first floor bedroom and / or bathroom. One can also prepay funeral / burial expenses and pay off existing debt, such as one’s mortgage. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s “Look-Back” period” and can result if a period of Medicaid ineligibility. When “spending down”, it is best to keep documentation of how assets were spent as evidence the look back period was not violated.
3) 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 these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible and to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Louisiana Medicaid Programs
1) Adult Day Care Waiver – Also called the Adult Day Health Care (ADHC) Waiver, this program provides adult day care for elderly and disabled Louisiana residents to prevent and / or delay institutionalization.
2) LT-PCS Program – The Long Term – Personal Care Services 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 (CCW) – This waiver is intended for those who would require nursing home placement if not for the services available via this program. Benefits, such as respite care, adult day care, temporary skilled nursing, and assistive technology is available to those residing at home, in assisted living, or adult foster care.
4) Program of All-Inclusive Care for the Elderly (PACE) – Through PACE, the benefits of Medicare and Medicaid, including long-term care, are available via one program.
How to Apply for Louisiana Medicaid
Persons can apply for Medicaid in Louisiana online at LA Medicaid / LaCHIP – Self Service Portal, by calling Medicaid customer service at 1-888-342-6207, or in person at a Medicaid Application Center. Since walk in applications are not accepted at all application centers, applicants should first contact their local center. One’s local Area Agency on Aging office can provide assistance with the application process.
Prior to applying for Medicaid, it is imperative that Louisiana seniors be certain all eligibility requirements discussed above are met. If one is over the income and / or asset limit(s), or are unsure if they meet the eligibility criteria, Medicaid planning can be invaluable. The application process, which can be lengthy, is also complicated. For additional information on applying for long-term care Medicaid, click here.