Louisiana Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Louisiana provides long-term care resources to seniors through the Louisiana Governor's Office of Elderly Affairs (GOEA) was created in 1956 as the Commission on Aging by the Louisiana Legislature to act as the state's visible advocate and focal point for all matters pertaining to the aging population. Accordingly, all programs and services for the elderly population of Louisiana are consolidated within the GOEA. GOEA is the administrator of the Older Americans Act (OAA) program services.

Other services provided through GOEA are Elderly Protective Services, Long Term Care Ombudsman, Aging and Disability Resource Centers (ADRC), SenioRx Prescription Assistance, National Family Caregiver Support, Community Living Program, Alzheimer's disease Supportive Services Program and the Senior Employment. GOEA is currently planning provider agreements to begin implementing the Veterans Directed Home and Community Based Services Program (VDHCBS).

In addition to the services provided by GOEA, theLouisiana Department of Health, Office of Aging and Adult Services oversees the state’s home-and-community based (HCBS) Medicaid waiver programs for seniors over 65 needing a nursing home level of care but choose to remain in their community, a residential or assisted living setting, or their own home.

Medicaid Waiver Programs for Assisted Living and In Home Care

The Office of Aging and Adult Services (OAAS) administers home and community based long-term care services (HCBS) through various waiver and state plan programs for individuals who are elderly or have disabilities, assisting them to remain in their homes and in the community. The intent of these HCBS programs is to provide services and supports that are not otherwise available and that assist an individual to remain in or return to the community. These programs do not individually or in combination provide 24-hour-per-day supports. This means that in many cases it may be necessary and desirable for individuals to use other paid and unpaid supports at their disposal.

Louisiana Community Choices Waiver (CCW HCBS Medicaid Waiver)

The Community Choices Waiver (CCW) serves seniors and persons with adult onset disabilities as an alternative to nursing facility care. Based on a standardized assessment, each recipient is provided a budget based on acuity to create an individual service package.

Services

Services included in the CCW program: support coordination, nursing and skilled therapy assessments and services, in-home monitoring systems, home modifications and assistive technologies, personal care, home-delivered meals, monitored in-home caregiving, and caregiver respite.

Eligibility

  1. Health: An applicant must meet a Nursing Home Level of Care.
  2. Financial: An applicant is subject tocertain income and asset limits. Single people can have no more than $2,000 in resources. Couples can have no more than $3,000 in resources (when both spouses receive long-term care). Married couples can have up to $120,900 in resources, as long as one spouse at home DOES NOT receive long-term care services. The income limits are $2,205 for an individual and $4,410 for a couple (when both spouses need long-term care). However, there is a “Waiver Spend-down” option which allows your eligibility to be considered even if your income is over the limit. Waiver Spend-down has a standard $20 income deduction. After the income deductions are applied, the average monthly waiver rate (currently $4,000 for OAAS waivers) and other allowable incurred medical expenses are used to “spend-down” an individual’s excess income, qualifying the individual for Waiver. All individuals are allowed to retain a basic needs allowance from his/her income which is equal to $2,205 (300% of the Federal Benefit Rate, or FBR). Any remainder will be the individual’s liability for the cost of care in Waiver Spend-down

Practical Considerations

In order to request application for the waiver, the Department keeps a waiting list of people who have asked for these services, along with the date of the request. Persons are offered the Community Choices Waiver according to the following priority groups:

(1) People with abuse or neglect referred by Adult Protective Services (APS) who, without Community Choices Waiver services, would need institutional placement to prevent further abuse and neglect; (2) People diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease; (3) People who are residing in a State of Louisiana Permanent Supportive Housing unit or who are linked for the State of Louisiana Permanent Supportive Housing selection process; (4) People residing in a Louisiana nursing facility if they have been approved for a stay of more than 90 days; (5) People who are not presently receiving home and community-based services under another approved Medicaid Waiver program.

Louisiana Adult Day Health Care Medicaid Waiver (ADHC HCBS Waiver)

Adult Day Health Care (ADHC) is a non-residential program that can be an alternative to nursing home care for people who do not need care 24 hours a day, 7 days a week. This program does not, by itself or in combination with other OAAS programs, provide supports 24 hours a day. ADHC, through health and social services, provides supervised care to adults in a supportive and safe setting during part of a day. An individual assessment of each client determines the services provided.

ADHC centers typically operate during daytime hours, Monday through Friday, although some centers may offer evenings or weekends. The intent of adult day health care is primarily twofold: 1) To provide older adults an opportunity to receive medical, health and social services in a supportive structured environment; and 2) To assist families/caregivers to continue to care for their loved ones in the home and in the community through hours in ADHC, providing the family the opportunity to fulfill daily responsibilities.

Services

Services includedin the ADHC program: medical/nursing services, medication supervision/administration, social services, personal care and dietary services (serving both regular and special diet hot lunches as well as morning and afternoon snacks); as well as Support coordination (also known as case management), Transition Intensive Support Coordination (provided to people moving out of nursing homes), Transitional Services (provided to people moving out of nursing homes)

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: An applicant is subject tocertain income and asset limits. Single people can have no more than $2,000 in resources. Couples can have no more than $3,000 in resources (when both spouses receive long-term care). Married couples can have up to $120,900 in resources, as long as one spouse at home DOES NOT receive long-term care services. The income limits are $2,205 for an individual and $4,410 for a couple (when both spouses need long-term care). However, there is a “Waiver Spend-down” option which allows your eligibility to be considered even if your income is over the limit. Waiver Spend-down has a standard $20 income deduction. $65 and ½ of the remainder is also deducted from all earned income. After the income deductions are applied, the average monthly waiver rate (currently $4,000 for the ADHC Waiver) and other allowable incurred medical expenses are used to “spend-down” an individual’s excess income, qualifying the individual for Waiver. All individuals are allowed to retain a basic needs allowance from his/her income which is equal to $2,205 (or 300% of the Federal Benefit Rate, FBR). Any remainder will be the individual’s liability for the cost of care in Waiver Spend-down.

Practical Considerations

The Department keeps an Adult Day Health Care (ADHC) Waiver Request waiting list of people who have asked for these services, along with the date of the request. Persons are offered the Adult Day Health Care (ADHC) Waiver according to the following priority groups: (1) People with abuse or neglect referred by Adult Protective Services (APS) who, without ADHC Waiver services, would need institutional placement to prevent further abuse and neglect; (2) People who have been discharged after a hospitalization within the past 30 days that involved a stay of at least one night; and, (3) People residing in a Louisiana nursing facility if they have been approved for a stay of more than 90 days.

Conclusion

Louisiana provides two different programs pursuant to the home-and-community based Medicaid waiver and the same healthcare and financial criteria apply to both. Because the state has a Special Income Limit (SIL), in order to meet the strict financial criteria it would be essential to use a Medicaid Planning specialist. This person can help you determine whether your income and assets will qualify you for the waiver program, and assist with any actions under the “medically-needy” provisions which allow for the spenddown of certain income to meet the strict financial criteria.