Individuals who qualify for LTC services provided in a Medicaid-certified facility or at home in the community must:
* The Office of Aging and Adult Services (OAAS) or Office for Citizens with Developmental Disabilities (OCDD) make the determination of functional/medical eligibility (level of care) for individuals applying for or who are receiving Medicaid-funded facility care or HCBS.
Individuals who need the type of medical care usually available in facilities, but who can be successfully and cost-effectively treated in other settings, may be allowed to receive the necessary care at home or in the community. Home and community-based services provide help to qualified individuals who can safely remain in or return to the community as an alternative to placement in a facility. HCBS does not provide 24 hour per day supports. Home and community-based services (HCBS) are available through the following programs:
Individuals who are aged, blind, or disabled and eligible for Medicaid outside the facility may qualify to receive long-term personal care services (LTPCS) in their homes even without being in one of the waiver service programs.
Except for LTPCS, the Medicaid financial and non-financial requirements for waiver are the same as for nursing or ICF/IID facility care.
For information about the OAAS CCW, ADHC, PACE, or LTPCS programs or to request services, call
1-877-456 -1146 (TDD: 1-877-544-9544) Monday through Friday between the hours of 8 a.m. and 5 p.m. The call is free.
For information about the OCDD CCW, NOW, SW, or ROW programs or to request services, call the Office for Citizens with Developmental Disabilities at 1-866-783-5553 or your local Human Services District and Authority.
Medicaid sends the “Ways to Apply” letter when a person is admitted to a nursing home or offered a waiver opportunity. Be sure to apply for Medicaid using one of the following ways:
1.) Apply online by visiting the Medicaid Self-Service Portal.
2.) Download and print an application. Then mail or fax it to Medicaid as directed on the form.
3.) Call Medicaid Customer Service toll free at 1-888-342-6207 to apply by phone.
4.) Apply in person at your local Medicaid office.
You must answer all of the questions on the application form and give the needed proof so we can see if the person who needs long-term care services is eligible for Medicaid. If you do not apply, Medicaid cannot decide if the person is eligible for benefits.
Yes, with the appropriate documentation that gives you permission to act on behalf of your parent.
See the current income limits. These limits usually increase each year in January. People with income above these limits may still qualify for long-term care services through the Medically Needy Spend-Down Program. For more information, please call 1-800-230-0690.
Medically Needy provides Medicaid eligibility to qualified individuals and families who may have too much income to qualify for regular Medicaid programs. Individuals and families who meet all Medicaid program requirements, except that their income is above those program limits, can spend-down or reduce their income to Medicaid eligibility levels using incurred medical expenses.
Countable income consists of:
We count the gross monthly income of the person applying for long-term care or waiver to decide if he or she is eligible. The eligible person is commonly expected to use their income to pay a share of the cost of services provided in a nursing home. Medicaid will pay the remaining amount owed for their cost of care.
To determine how much the person pays for their care, Medicaid uses the eligible person’s gross monthly income and then deducts for personal care needs, Medicare and health insurance premiums, incurred medical expenses not covered by Medicaid, and contributions made to a spouse or dependents living at home. After the deductions are applied, any remaining income must be paid toward their care.
An eligible person may give some of their income to a legal spouse and/or to children under age 18 living in the eligible person’s home. There are limits to how much can be given to the spouse and children. To decide how much can be given, we need income information about the spouse and/or children.
Resources are cash money and any other personal property or real property that could be converted to cash and used for support and maintenance. Resources include checking and savings accounts, mutual fund shares, certificates of deposit, stocks, bonds, life insurance, real estate, annuities, trust, and more. The value of the resource is counted as of the first moment of the first day of the month, less encumbrances.
Countable resources cannot be worth more than $2,000 for an individual or $3,000 for a couple. Under Spousal Impoverishment rules, a married individual with a spouse living at home can have a certain amount of the couple’s countable resources protected for the spouse living at home. All resources owned separately by either spouse and owned jointly by the couple are used to determine the total countable resources.
Some resources do not count toward the resource limit. These resources usually include the home property, one vehicle, cash surrender value of life insurance policies with a combined face value of $10,000 or less, paid burial spaces, and irrevocable burial arrangements.
Individuals may not qualify for payment of LTC or HCBS waiver services, if the value of the home property is greater than the home equity limit or a transfer of resources for less than fair market value occurred during or after the 60 month look-back period.
Medicaid must look at any transfer of resources made by the applicant or applicant’s spouse which occurred during the 60 months before the application date or at any time after application. Transfers for less than fair market value are presumed to have been done to qualify for Medicaid, unless the applicant provides convincing evidence that the transfer was done exclusively for another purpose. If it is determine that resources were transferred to qualify for Medicaid, the person who needs long-term care will not be eligible for payment of facility care or waiver services for a specified period. Medicaid uses the difference between the value of the transferred item and what the person received in return to determine how long the person will not be eligible for payment.
When a long-term care recipient dies, Estate Recovery provisions require that we take steps to recover the cost of certain Medicaid payments from his or her estate. These costs include the total amount of payments for facility or waiver services, hospital care, and prescription drugs the person received at age 55 or older.
In most cases, we will make an eligibility decision and notify you of our findings within 45 days. If we must make a disability decision, it may take up to 90 days. Coverage can start as early as three months before the month of application if all eligibility factors for Medicaid were met.
Changes must be reported to us within 10 days if the person who gets Medicaid or his/her legal spouse:
You have the right to appeal the Medicaid decision. There are several ways to request an appeal. You can write the reason you disagree with the decision on the back of the decision letter and then mail or fax it to Medicaid as directed on the letter. You can also fax the decision letter to the Division of Administrative Law at 225-219-9823 or mail it to the Division of Administrative Law, Department of Health Section, P. O. Box 4189, Baton Rouge, LA 70821-4183. You can request an appeal by phone by calling Medicaid Customer Service at 1-888-342-6207 or the Division of Administrative Law at 225-342-5800.
Health and fire-safety inspections with detailed and summary information about deficiencies found during the three most recent comprehensive inspections (conducted annually) and the last three years of complaint investigations are found on the Medicare.gov Nursing Home Compare website.
Nursing Home Compare allows consumers to search for a nursing home based on location and compare the quality of care they provide and their staffing. Nursing Home Compare has detailed information about every Medicare and Medicaid-certified nursing home in the country.
For information about Louisiana nursing homes or any other nursing home inquiry, contact the LDH Health Standards Section, Nursing Home Program Desk at 225-342-0114 or visit the Louisiana Nursing Home Association website. Nursing home providers are required to post the results of their most recent inspection in the facility.