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.