For Louisiana families receiving developmental disability services, both age 18 and age 21 are important, but they do not mean the same thing.
If your child receives or may need OIDD waiver services, age 21 is generally the bigger Medicaid service transition.
At age 18, a young person becomes a legal adult in Louisiana, Social Security may reevaluate childhood SSI under the adult disability rules, and certain waiver choices may become available.
But a young person receiving the Children’s Choice Waiver does not automatically age out at 18.
Under current Louisiana rules, Children’s Choice can continue through age 20. At age 21, the participant ages out of Children’s Choice and, if they remain eligible for waiver services, transitions to the adult OIDD waiver that is appropriate for their needs. EPSDT benefits also end at age 21.
Important: This article provides general educational information only. It does not determine a person’s Medicaid, waiver, SSI, legal, or service eligibility. Individual transition plans can differ based on the person’s waiver, Medicaid eligibility, assessed needs, services, and circumstances.
Age 18 vs. Age 21: What’s the Difference?
Here is the simplest way to think about the two ages:
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At age 18 |
At age 21 |
|
The person becomes a legal adult in Louisiana |
Children’s Choice Waiver eligibility ends |
|
SSI childhood disability is generally redetermined using adult disability rules |
Eligible Children’s Choice participants transition to an appropriate adult OIDD waiver |
|
A Children’s Choice participant can generally remain in Children’s Choice |
EPSDT benefits end |
|
A qualifying young adult interested in employment may have the option to move to Supports Waiver |
Some services previously received through EPSDT must transition to adult Medicaid or waiver pathways |
|
Decision-making and authorization issues may need to be reviewed |
The person’s adult waiver and adult service package become especially important |
So for families asking:
“When do waiver services really change, 18 or 21?”
Usually, age 21 is the more significant waiver-service milestone.
What Happens to Children’s Choice Waiver at Age 18?
It does not automatically end.
Louisiana’s current Children’s Choice Waiver information states that the waiver serves individuals ages 0 through 20.
A participant who turns 18 can continue receiving Children’s Choice Waiver services as long as they continue to meet the applicable eligibility requirements.
This is an important point because families sometimes assume:
“My child turns 18, so they have to move to an adult waiver.”
That is not generally how Louisiana’s current Children’s Choice transition works.
There is an optional waiver change at 18 for some young adults
Age 18 does create an additional waiver option in certain circumstances.
LDH currently states that a youth who reaches age 18 and wants to work may choose to transition from Children’s Choice to the Supports Waiver, as long as the individual remains eligible for waiver services.
The Supports Waiver is available to qualifying individuals age 18 and older and includes employment- and community-focused services such as:
- Supported employment
- Day habilitation
- Prevocational services
- Habilitation
- Respite
- Certain housing stabilization services
- Personal emergency response systems
- Support coordination
Moving to Supports Waiver at 18 is therefore an option in applicable situations, not a requirement for every Children’s Choice participant.
Families should evaluate the individual’s actual support needs and goals through the applicable person-centered planning process rather than assuming one waiver is automatically better than another.
Why Does Age 18 Still Matter?
Even though Children’s Choice does not end at 18, turning 18 is still an important transition point.
- The person becomes a legal adult
Under Louisiana law, the age of majority is 18.
That can affect who has authority to make decisions, sign documents, authorize information sharing, and participate in certain processes on the person’s behalf.
It does not mean every person with a disability needs interdiction, guardianship, or another legal arrangement.
The appropriate decision-making arrangement depends on the individual. Families with questions about legal authority should obtain information appropriate to their circumstances rather than assuming that a disability automatically requires another person to make decisions.
- SSI uses adult disability rules
For a young person who received Supplemental Security Income (SSI) based on childhood disability, Social Security generally conducts an age-18 disability redetermination.
SSA evaluates whether the person meets the disability standard used for adults rather than simply continuing the childhood determination.
This is important because SSI can affect a person’s broader benefits situation.
However:
Turning 18 does not automatically mean SSI continues, ends, or that Medicaid waiver eligibility changes.
SSI, Medicaid, and OIDD waiver eligibility involve separate rules and determinations.
Families should not assume the outcome of one program automatically determines the outcome of another.
What Happens at Age 21?
For waiver participants, this is the major transition point.
Children’s Choice ends at 21
Louisiana currently states that individuals who remain in Children’s Choice after age 18 age out when they reach their 21st birthday.
If the individual continues to meet the requirements for waiver services, Louisiana’s approved Children’s Choice waiver provides for the participant to transition to an appropriate HCBS waiver serving adults.
This does not mean everyone automatically moves to NOW.
That is another important misconception.
Louisiana uses a tiered OIDD waiver system.
The adult waiver should be the waiver appropriate to the individual’s assessed needs rather than automatically being the New Opportunities Waiver.
Depending on the individual, adult OIDD waiver options can include:
- Supports Waiver
- Residential Options Waiver (ROW)
- New Opportunities Waiver (NOW)
The appropriate waiver depends on the person’s support needs and applicable eligibility requirements.
Does a Children’s Choice Participant Have to Go Back on the Waiver Waiting List at 21?
A person already receiving Children’s Choice does not simply age out at 21 and start over as a new person waiting for an adult waiver opportunity.
Louisiana’s approved Children’s Choice waiver states that participants aging out of Children’s Choice transfer with their waiver slot to an appropriate adult HCBS waiver, provided they continue to meet the applicable eligibility requirements.
That is a very important distinction for families.
The transition still requires planning and eligibility requirements must continue to be met, but age 21 is intended to be a transition between waiver programs, not simply termination of the participant’s waiver because they reached adulthood.
When Should the Age-21 Waiver Transition Start?
It should begin before the 21st birthday.
Louisiana’s current Children’s Choice provider manual instructs Support Coordinators to begin the age-21 transition process no less than 90 days before the participant’s 21st birthday.
That transition should address issues such as:
- Which adult waiver is appropriate
- Current support needs
- Services currently being received
- Services that may need to change
- Providers
- Personal-care needs
- Employment or day-service goals
- Nursing or professional-service needs
- Equipment and supplies
- The person’s living arrangement
- Other Medicaid services that may change at 21
Families should not wait until the week before the participant turns 21 to begin asking what will happen.
EPSDT Also Ends at Age 21
Age 21 is significant for another major reason:
EPSDT applies to Medicaid members under age 21.
Louisiana Medicaid provides a broad set of medically necessary benefits to Medicaid-eligible children and young adults through Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
When the person reaches age 21, they age out of EPSDT.
Louisiana has even published a specific Guide to Aging Out of EPSDT for Medicaid members turning 21.
This does not necessarily mean the person loses Medicaid.
It means the Medicaid benefit structure changes from the under-21 EPSDT benefit to the benefits and services available to adults under the person’s applicable Medicaid coverage.
Some adult services may continue.
Some may have different requirements.
Some services available through EPSDT may not have an identical adult Medicaid benefit.
And other needs may be addressed through the participant’s adult waiver.
What Happens to Personal Care Services at 21?
This is one area families should pay particular attention to.
Louisiana currently states that Medicaid recipients ages 0 through 20 use the EPSDT Personal Care Services pathway when they meet the applicable requirements.
At age 21, EPSDT-PCS ends.
Louisiana has adult personal-care pathways, including Long-Term Personal Care Services (LT-PCS) for qualifying adults age 21 and older with disabilities.
But LT-PCS has its own eligibility requirements, including Medicaid eligibility, nursing-facility level of care, functional criteria, and additional program requirements.
A young adult should therefore not assume that EPSDT-PCS automatically converts into the same number of LT-PCS hours on the 21st birthday.
The adult service has a separate eligibility and assessment process.
This is exactly the type of service that should be reviewed as part of age-21 transition planning.
Will All of the Same Services Continue at 21?
Not necessarily.
The transition from childhood to adult services is not simply a change in the name of the waiver.
Before age 21, a participant may receive a combination of:
- Children’s Choice services
- EPSDT services
- Medicaid State Plan services
- Personal Care Services
- Nursing
- Therapy
- Medical equipment and supplies
- Behavioral health services
- Other supports
At age 21, both the Children’s Choice Waiver and EPSDT framework change.
The adult OIDD waiver may cover some needs, while other adult Medicaid services may cover others.
The exact mix depends on the person’s needs, eligibility, adult waiver, and applicable Medicaid requirements.
This is why the transition should look at the participant’s whole support system, rather than simply asking:
“Which waiver will they get?”
What Should Families Review Before Age 21?
For a Children’s Choice participant approaching 21, some useful questions for the transition-planning process include:
- Which adult OIDD waiver is expected to meet the participant’s needs?
- When will the formal waiver transition process begin?
- Which current Children’s Choice services will change?
- Which current services are actually EPSDT services rather than waiver services?
- Which EPSDT services need an adult coverage pathway?
- Does the participant currently receive EPSDT Personal Care Services?
- Will an adult personal-care assessment be needed?
- Are nursing services involved?
- Are medical equipment or supply needs likely to change?
- Does the participant have employment or day-service goals?
- Are current providers able to provide the applicable adult services?
- Are any new assessments or authorizations required?
- Is the participant’s Medicaid eligibility current?
- Are decision-making and information-sharing arrangements clear now that the participant is an adult?
These are planning questions—not indications that any particular adult service or waiver is guaranteed.
What Is the Support Coordinator’s Role?
For a participant already receiving Children’s Choice Waiver services, Support Coordination is an important part of the age-21 transition process.
Louisiana’s Children’s Choice provider manual specifically assigns the Support Coordinator responsibilities related to planning the transition to the appropriate adult waiver.
That can include coordinating with the participant and others chosen by the participant to identify:
- Current needs
- Future goals
- Necessary supports
- Appropriate services
- Transition issues that need to be addressed before age 21
The Support Coordinator does not independently decide which services Medicaid will authorize and should not guarantee that a particular waiver, service, provider, or number of hours will be approved.
Final eligibility and authorization decisions are made through the applicable Louisiana Medicaid and OIDD processes.
So Which Birthday Should Families Pay More Attention To?
Both, but for different reasons.
Age 18 is primarily an adulthood and planning milestone.
At 18:
- The person becomes a legal adult in Louisiana.
- SSI childhood disability may be redetermined under adult rules.
- Children’s Choice can generally continue.
- Certain young adults interested in employment may have the option to transition to Supports Waiver.
Age 21 is the major Medicaid waiver and service transition.
At 21:
- Children’s Choice Waiver ends.
- A participant who remains eligible transitions to the appropriate adult OIDD waiver.
- EPSDT ends.
- EPSDT Personal Care Services end.
- Adult Medicaid and waiver service pathways become applicable.
- Some services, authorization rules, providers, or benefits may change.
For a family receiving Children’s Choice Waiver, I would consider age 21 the bigger service-transition birthday.
But planning should begin well before then.
The Bottom Line
If your child has a developmental disability and receives Louisiana waiver services, turning 18 does not generally mean that Children’s Choice Waiver ends.
Children’s Choice currently serves qualifying participants through age 20.
At age 18, important changes occur because the person becomes an adult, SSI may be redetermined under adult disability standards, and certain waiver options, such as Supports Waiver for eligible youth pursuing employment—may become available.
The larger waiver transition occurs at age 21.
At that point:
Children’s Choice ends + EPSDT ends + the participant transitions into the appropriate adult OIDD waiver if they continue to meet waiver eligibility requirements.
Louisiana’s waiver rules are designed for that transition to begin before the participant’s 21st birthday, rather than waiting until services are about to change.
For families, the most useful approach is to treat 18 as the beginning of adult-transition planning and 21 as the major Medicaid/waiver transition point.
Important Information: This article is provided solely for general educational and informational purposes. It is not legal, medical, Medicaid eligibility, waiver eligibility, Social Security, or benefits-planning advice. Nothing in this article guarantees continued Medicaid or waiver eligibility, transition to a particular adult waiver, authorization of a particular service, continuation of existing service levels, or eligibility for SSI or another benefit. Transition requirements and available services can depend on the individual’s Medicaid eligibility, waiver, assessed needs, level-of-care determination, age, services, and other circumstances. Program rules may also change. Official Medicaid and waiver eligibility and service-authorization decisions are made by the Louisiana Department of Health, Louisiana Medicaid, OIDD, and other applicable government authorities. Social Security makes SSI eligibility determinations.
Our agency is an independent Louisiana Support Coordination Agency and is not the Louisiana Department of Health, Louisiana Medicaid, OIDD, the Social Security Administration, or another government agency. References to government programs are provided solely for educational purposes.
