Yes, in some circumstances. Louisiana Medicaid has several home and community-based programs designed to help qualifying older adults and adults with disabilities receive long-term care services at home or in the community rather than in a nursing facility.
Depending on the person’s needs and eligibility, options may include:
- Community Choices Waiver (CCW)
- Long-Term Personal Care Services (LT-PCS)
- Adult Day Health Care (ADHC) Waiver
- Program of All-Inclusive Care for the Elderly (PACE)
Louisiana also has programs that may help some Medicaid recipients who are already living in a nursing facility return to the community.
However, Medicaid home and community-based services are not the same as providing around-the-clock nursing-home care in someone’s home. Eligibility, service availability and the amount and type of assistance authorized depend on the individual and the program.
Important: This article provides general educational information only. It does not determine whether someone qualifies for Medicaid, an OAAS program, a particular number of service hours, or whether living at home is appropriate or safe for a particular person. Those determinations are made through the applicable Louisiana Medicaid and OAAS processes.
What Are Home and Community-Based Services?
Louisiana’s Office of Aging and Adult Services (OAAS) administers long-term care programs for older adults and people with adult-onset disabilities.
Home and Community-Based Services, often called HCBS, are intended to help qualifying individuals receive needed long-term services in their homes or other community settings instead of receiving all of their care in an institution.
Depending on the program and person’s needs, assistance can include things such as:
- Bathing and dressing
- Toileting
- Eating and meal preparation
- Mobility and transfers
- Personal care
- Nursing services
- Home modifications
- Assistive devices
- Emergency response systems
- Adult day services
- Home-delivered meals
- Caregiver respite
- Monitored in-home caregiving
- Support coordination
Not every program provides every service.
Do You Have to Need Nursing Home Care to Qualify for Services at Home?
This can sound contradictory, but for several Louisiana long-term care programs, yes.
A person may need to meet what Louisiana calls nursing facility level of care to qualify for certain home and community-based services.
Meeting nursing facility level of care does not automatically mean the person must live in a nursing home.
Instead, it establishes that the person’s care needs are significant enough to meet the applicable long-term-care standard. If the person can safely receive appropriate services in the community and meets the other program requirements, a home and community-based option may be available.
This distinction is one reason families should not assume that needing substantial help with daily activities automatically means nursing-home placement is the only Medicaid option.
Option 1: Community Choices Waiver
The Community Choices Waiver (CCW) is one of Louisiana’s primary Medicaid home and community-based programs for older adults and people with adult-onset disabilities.
Louisiana describes CCW specifically as an alternative to nursing facility care.
To qualify, an individual generally must:
- Meet Louisiana Medicaid long-term-care eligibility requirements
- Be 21 years of age or older
- Meet nursing facility level of care
CCW offers a broad range of services that may help a qualifying participant continue living in the community.
Services can include:
- Support coordination
- Personal assistance services
- Nursing
- Physical, occupational and speech therapy
- Adult day health care
- Home-delivered meals
- Personal emergency response systems
- Assistive devices and medical supplies
- Home accessibility modifications
- Assistive technology
- Caregiver temporary support or respite
- Monitored in-home caregiving
- Certain housing-related supports
The exact services a participant receives are based on the person’s assessed needs and approved Plan of Care.
Does CCW provide 24-hour care at home?
No.
Louisiana specifically states that the Community Choices Waiver does not provide assistance 24 hours per day.
This is an important limitation.
Some people can safely remain at home using a combination of Medicaid services, informal family or caregiver support, Medicare or other health services, community resources and other assistance.
Others may have needs that cannot safely be met through the available home and community-based services.
Whether remaining at home is appropriate must therefore be evaluated individually.
Is There a Waiting List for Community Choices Waiver?
There can be a wait for a CCW opportunity.
Louisiana maintains a request list for Community Choices Waiver services and uses several priority groups when offering available opportunities.
Current priority groups include certain individuals who:
- Have experienced abuse or neglect and would otherwise need nursing-facility care
- Have ALS
- Are connected with Louisiana Permanent Supportive Housing
- Are already living in a nursing facility with Medicaid as the sole payer
- Are receiving the maximum LT-PCS benefit and are at risk of nursing-home placement without additional services
- Meet certain other HCBS circumstances established by OAAS
People outside the priority groups generally receive offers based on the date they requested services as opportunities become available.
For that reason, being eligible for CCW does not necessarily mean that services can begin immediately.
Option 2: Long-Term Personal Care Services
A person does not necessarily need a waiver to receive all Medicaid-funded assistance at home.
Louisiana’s Long-Term Personal Care Services (LT-PCS) program is a Medicaid State Plan service that provides personal assistance to qualifying adults.
LT-PCS can help with activities such as:
- Bathing
- Dressing
- Grooming
- Toileting
- Eating
- Walking or using a wheelchair
- Getting in and out of a bed or chair
- Repositioning in bed
Depending on the person’s needs, assistance may also include:
- Light housekeeping
- Preparing and storing meals
- Grocery shopping
- Laundry
- Medication reminders
- Help scheduling medical appointments
- Arranging medical transportation
Who may qualify for LT-PCS?
Current Louisiana requirements include that the person:
- Receives Medicaid
- Is 21 or older
- Qualifies for nursing-home level of care
- Requires at least limited assistance with an Activity of Daily Living
- Can direct their care independently or through a responsible representative
The individual must also meet additional program targeting criteria.
For example, the person may:
- Be living in a nursing facility but capable of discharge if community services were available;
- Be likely to require nursing-facility admission within the next 120 days; or
- Have a primary caregiver who has a disability or is at least 70 years old.
LT-PCS is therefore particularly relevant when a family is asking:
“My parent is starting to need significant help at home. Does Medicaid have anything available before nursing-home placement becomes necessary?”
It may be one program worth having Louisiana Options in Long-Term Care evaluate.
What doesn’t LT-PCS provide?
LT-PCS is primarily a personal-care service.
It does not replace all medical or long-term-care services and does not provide services such as nursing care, medication administration, physical therapy, occupational therapy or speech therapy through the LT-PCS benefit itself.
Louisiana also specifically states that LT-PCS does not provide 24-hour support.
What If LT-PCS Is Not Enough?
Some individuals have needs beyond what LT-PCS can provide.
Louisiana’s current Community Choices Waiver priority system specifically recognizes individuals who are receiving 32 hours per week of LT-PCS and would require nursing-facility placement without additional services.
Qualifying individuals in that circumstance may potentially be considered for an expedited CCW opportunity under the state’s current priority structure.
That does not mean receiving 32 hours automatically results in a waiver.
The individual must meet the applicable requirements, including the state’s determination that nursing-facility placement would otherwise be necessary.
Still, this is important for families to know because a significant increase in needs should not simply be viewed as:
“LT-PCS isn’t enough anymore, so a nursing home is the only option.”
There may be other OAAS processes that should be evaluated.
Option 3: Adult Day Health Care Waiver
Louisiana also operates the Adult Day Health Care (ADHC) Waiver.
ADHC provides supervised health, personal-care and social services in a licensed adult day health care center during part of the day.
Current eligibility requirements include:
- Meeting Medicaid long-term-care eligibility
- Being 22 years of age or older
- Meeting nursing facility level of care
At an ADHC center, services may include:
- Nursing and health monitoring
- Assistance with medications
- Personal care
- Meals
- Structured activities
- Social interaction
- Transportation to and from the center in many situations
The waiver can also include other supports such as:
- Support coordination
- Home-delivered meals
- Personal emergency response systems
- Activity and sensor monitoring
- Health-status monitoring
Adult Day Health Care can be particularly useful when someone can remain at home but needs supervision, assistance or health monitoring during portions of the day.
As with Louisiana’s other OAAS home and community-based programs, ADHC does not provide 24-hour care.
Option 4: PACE
For some older adults, PACE — the Program of All-Inclusive Care for the Elderly — may be another option.
PACE is designed to coordinate a broad range of medical, social and long-term-care services so qualifying older adults can continue living in the community.
To qualify for PACE, a person generally must:
- Be 55 years of age or older
- Live within an established PACE service area
- Meet nursing facility level of care
- Be able to live safely in the community at the time of enrollment
PACE uses an interdisciplinary team that can include physicians, nurses, therapists, social workers and other professionals to coordinate the participant’s care.
Services can include Medicare and Medicaid-covered services as well as additional supports determined necessary through the PACE care-planning process.
PACE is currently available only in defined Louisiana service areas, so it is not an option in every parish.
A person does not necessarily have to already qualify for Medicaid simply to explore PACE; however, Medicaid eligibility requirements apply if Medicaid will pay for the individual’s PACE services.
What If My Parent Is Already in a Nursing Home?
Being admitted to a nursing facility does not necessarily mean the person must remain there permanently.
Louisiana has programs intended to help qualifying individuals transition from institutional care back into the community when doing so is appropriate and the person chooses to return home or to another community setting.
Community Choices Waiver transition services
CCW includes specific services for qualifying participants who are moving out of a nursing facility.
These can include:
Transition Intensive Support Coordination
A Support Coordinator assists with planning and coordinating the move from the nursing facility into the community.
Transition Services
Certain items needed to establish a community living arrangement may be covered under applicable program requirements.
My Place Louisiana
Louisiana also operates My Place Louisiana, which helps qualifying Medicaid recipients transition from institutional settings to home and community-based services.
For the OAAS population, current eligibility generally includes:
- Medicaid eligibility
- Qualification for an applicable OAAS waiver
- Residence in a nursing facility for at least 60 consecutive days
- Eligibility for home and community-based services
- Transitioning into the community
Depending on the individual’s circumstances, My Place Louisiana may also assist with certain transition-related needs not otherwise covered through regular Medicaid benefits.
So if a family member is already in a nursing home but wants to return to the community, it can be worth asking whether a transition program is available rather than assuming the nursing-facility placement is permanent.
What If We Need Help at Home Right Now?
A useful starting point is Louisiana Options in Long-Term Care.
Louisiana uses this resource as the point of contact for individuals interested in OAAS home and community-based services, including:
- Community Choices Waiver
- Adult Day Health Care Waiver
- Long-Term Personal Care Services
- Other OAAS long-term-care options
Louisiana Options in Long-Term Care:
1-877-456-1146
An assessment may be needed to determine the person’s functional needs, nursing-facility level of care and which programs may be appropriate.
If the person already receives OAAS waiver services and has a Support Coordinator, significant changes in the person’s needs should also be communicated through the participant’s normal Support Coordination process.
Does Medicaid Decide Whether Someone Should Stay Home or Enter a Nursing Home?
Medicaid eligibility and service authorization are only part of the picture.
Whether an individual can safely remain in the community depends on the person’s actual circumstances, including:
- Physical needs
- Cognitive needs
- Behavioral or safety concerns
- Ability to be alone
- Medical needs
- Caregiver availability
- Housing
- Accessibility
- Authorized Medicaid services
- Other paid and unpaid supports
Louisiana specifically cautions that its OAAS home and community-based programs do not individually or collectively provide 24-hour-per-day support.
That means a Medicaid HCBS program should not be interpreted as a guarantee that every person who prefers to remain home can safely do so regardless of the level of care required.
The goal is instead to identify whether available community-based supports can appropriately and safely meet the person’s needs.
The Bottom Line
Can Louisiana Medicaid help an older adult stay out of a nursing home?
Yes. Louisiana Medicaid has several programs specifically designed to help qualifying older adults and adults with disabilities receive long-term care services at home or in the community.
Depending on the person’s circumstances, those options may include:
- Community Choices Waiver for a broad range of home and community-based supports
- Long-Term Personal Care Services for assistance with activities of daily living
- Adult Day Health Care Waiver for supervised daytime health and personal-care services
- PACE for comprehensive coordinated care in certain Louisiana service areas
And for someone already living in a nursing facility, Community Choices Waiver transition services and My Place Louisiana may provide pathways back into the community for qualifying individuals.
The important distinction is that needing nursing-facility level of care does not automatically mean that a person must receive that care in a nursing home.
At the same time, Medicaid HCBS does not guarantee 24-hour assistance at home, immediate program availability or that community living will be appropriate for every individual.
The most appropriate next step is to have the person’s needs and available options evaluated through Louisiana’s official long-term-care process.
Important Information: This article is provided solely for general educational and informational purposes. It is not legal, financial, medical, Medicaid eligibility, long-term-care placement, or benefits-planning advice. Nothing in this article guarantees that an individual will qualify for Medicaid, an OAAS program, a waiver opportunity, a particular service, a particular number of service hours, or the ability to remain safely in a home or community setting. Medicaid eligibility, nursing-facility level-of-care determinations, program eligibility, service authorization and waiver availability are determined by the Louisiana Department of Health, Louisiana Medicaid, OAAS and other applicable government authorities. Program rules and services may change and may apply differently based on individual circumstances.
Our agency is an independent Louisiana Support Coordination Agency and is not the Louisiana Department of Health, Louisiana Medicaid, OAAS, PACE, or another government agency. References to government programs are provided for informational purposes only
