Personal Care Services and Private Duty in Louisiana

• Children’s Choice |  337.262.5610
• Community Choice Waiver |  877.456.1146 | Waiting list is 7 years long and also must have full Medicaid
• LT-PCS | 877.456.1146 | Must have full Medicaid in order to apply
• NOW | 337.262.5610

The Children’s Choice waiver (CC) program provides services in the home and in the community to individuals 0 through 20 years of age, who currently live at home with their families or who will leave an institution to return home. This waiver provides an individualized support package with a maximum cost of $16,410 per year, and is designed for maximum flexibility. Youth who reach the age of 18 and want to work may choose to transition to a Supports Waiver as long as they remain eligible for waiver services. Youth who continue in the Children’s Choice Waiver beyond age 18 will age out of Children’s Choice Waiver when they reach their 21st birthday. They will transition to the most appropriate waiver that meets their needs as long as they remain eligible for waiver services.

This program is not intended to provide 24 hours a day support.

To qualify for the Children’s Choice Waiver, a person must:

• Meet Louisiana Medicaid eligibility and
• Are 0 through 20 years of age
• Have an OCDD Statement of Approval and
• Meet the Louisiana definition for developmental disability with manifested prior to age 22 (Revised Statue 25:451.2, paragraph (11) and
• Meet Intermediate Care Facility-Intellectual Disability (ICF-ID) Level of Care Criteria

The Community Choice Waiver is designed for residents of Louisiana aged 65 and over and for physically disabled individuals between the ages of 21 and 64. Waiver participants must require the level of care provided in a nursing home, but choose to receive that care outside of a nursing home environment. In addition to the medical eligibility requirements, individuals must be financially eligible to receive long-term care Medicaid.

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 and could be discharged with appropriate assistance, 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 2020, the monthly income limit for seniors is equivalent to the current SSI limit, which means an individual cannot receive an excess of $783 per month. For married applicants (with both spouses applying), the income limit is $1,175. There is also an asset limit, which as of 2020, is $2,000 for a single applicant and $3,000 for married applicants.

The NOW is only appropriate for those individuals whose health and welfare can be assured via an Individual Support Plan and for whom home and community-based waiver services represent a least restrictive treatment alternative. The NOW is intended to provide specific, activity focused services rather than continuous custodial care.

To qualify for the New Opportunities Waiver, a person must:

• Meet Medicaid Eligibility and
• Be 3 years of age or older and
• Have an OCDD Statement of approval and
• Meet the Louisiana definition of Developmental Disability per Revised Statue 25:451.2 Paragraph (11) and
• Meet Intermediate Care Facility-Intellectual Disability (ICF-ID) Level of Care Criteria, and
• Have needs that cannot be met by another OCDD Waiver

As of 2020, an individual’s monthly income cannot exceed more than 300% of the SSI Federal Benefit Rate (FBR). This currently means that an individual cannot have a monthly income greater than $2,349. In addition, an individual cannot have countable resources (assets) in excess of $2,000. For a married couple in which both spouses are applying for the Community Choices Waiver, the individual income limit is doubled. Therefore, the income limit is $4,698 / month. The asset limit is also slightly higher than is the individual limit at $3,000. In the case where just one spouse of a married couple is an applicant, the applicant spouse can have up to $2,349 a month in income. The income of the non-applicant spouse is not considered towards the applicant spouse’s eligibility. For non-applicant spouses who have little to no income, there is a monthly maintenance needs allowance that enables applicant spouses to transfer income to their non-applicant spouses. As of 2020, this amount may be as much as $3,216 / month. The couple’s assets, on the other hand, are considered jointly owned and are counted towards the applicant spouse’s eligibility. In addition to the $2,000 in assets the applicant spouse can retain, the non-applicant spouse can keep up to $128,640 of the couple’s assets. This is called a community spouse resource allowance. Both the spousal income allowance and spousal resource allowance is intended to prevent the impoverishment of non-applicant spouses.

While the asset limit for individuals and couples might seem low, several assets are considered exempt, which means they aren’t counted towards Medicaid’s eligibility limit. One’s home, with an equity value up to $595,000, an automobile, household belongings, personal items, and burial trusts, are all considered exempt items. However, one can still qualify for CCW if he or she exceeds the asset and /or income limit(s). For example, Louisiana Medicaid has a ‘Medically Needy’ clause where individuals who have very high medical bills relative to their income can still qualify. Individuals who have questions about the Medically Needy process, or who exceed the asset and / or income limit(s) should seek assistance qualifying for Medicaid prior to submitting their application paperwork.