Louisiana Medicaid for Seniors & Long-Term Care

The Community Choices Waiver provides home and community-based services for individuals age 21 and older with physical disabilities or who are elderly and meet nursing facility level of care. CCW allows people who would otherwise require nursing facility placement to receive services in their home or community settings — maintaining independence and, in most cases, costing Medicaid less per member than institutional care.

CCW enrollment is subject to available slots. If you need the waiver but there are no immediate openings, you may be placed on a waiting list. Louisiana prioritizes CCW openings for people referred due to abuse or neglect, people with ALS, people already in a nursing home paid solely by Medicaid, and people approved for expedited Long Term-Personal Care Services — everyone else is offered a slot on a first-come, first-served basis. Contact Louisiana Options in Long-Term Care at 1-877-456-1146 or your local Aging and Disability Resource Center to begin the application process.

Louisiana participates in the Program of All-Inclusive Care for the Elderly (PACE), which integrates medical care, personal care, adult day services, and social support under a single care team for seniors who qualify for nursing facility level of care but prefer to remain in the community. PACE operates through dedicated PACE sites in certain Louisiana parishes. To qualify, you must be 55 or older, meet nursing facility level of care, live in a PACE service area, and be enrolled in Medicaid — PACE serves as your MCO, replacing your current managed care plan.

Louisiana also operates a separate Supports Waiver for people with intellectual or developmental disabilities, administered through the Office for Citizens with Developmental Disabilities (OCDD). This waiver provides residential supports, employment services, and community participation services, and has a waiting list.

Louisiana Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance. If income exceeds the institutional Medicaid limit, Louisiana may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Louisiana's LDH operates an estate recovery program. The state may seek reimbursement from the estate of a Healthy Louisiana member who received long-term care services — nursing facility, HCBS waiver, PACE, or other institutional care — after age 55. Recovery is limited to the cost of those services; it does not apply to other Medicaid-covered health care. A surviving spouse, minor child, or disabled child living in the home provides grounds to defer recovery.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income, set by Louisiana Medicaid and published on their website. Medicaid also has a 60-month (5-year) lookback period for asset transfers; transfers for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care.

Long-term care Medicaid in Louisiana covers a range of institutional and home-based services for eligible seniors and adults with disabilities.