Through an innovative approach to providing services to people with developmental disabilities, the Louisiana Department of Health is effectively ending the 25-year-old waiting list for specialized home and community-based services. This new plan prioritizes the needs of people instead of the date they applied for services.

The new plan, or Tiered Waiver, means that individuals with a greater urgency of need will now be prioritized for receiving the most appropriate home and community-based services. Over two years ago, LDH’s Office for Citizens with Developmental Disabilities began a screening process to evaluate the needs of the more than 10,000 individuals who were on a waiting list for services. As of today, all of the people on this waiting list who have an urgent or emergent need for waiver services have received a waiver opportunity.

Previously, these community-based services, or waiver services, were offered on a first-come, first-serve basis, said Dr. Rebekah Gee, secretary of the Louisiana Department of Health.

“Now, we are putting people before process. The waitlist had been in place for more than 20 years, with the average wait time exceeding 10 years in some instances,” Gee said, “By prioritizing the needs of people over when they applied for this benefit, we are making a fundamental shift that will get vital services to those most in need, much, much sooner.”

Years of research and collaboration with individuals with developmental disabilities, families, providers and community organizations went into crafting this new system. Over the past year, the Office for Citizens with Developmental Disabilities assessed the needs of those who had applied for these services.

The screening, using a nationally accepted best practice, considered what services and supports were already in place, whether or not the person was eligible for Medicaid, the severity or complexity of the person’s disabilities, what additional supports may be needed and any changes in an individual’s life or living situation.

Each case was given a Screening for Urgency of Need (SUN) Score to determine the urgency of need for waiver services. Five levels of need, or tiers, were created.

  • 4-Emergent: Supports will be needed in the next 90 days. (7% of the individuals requiring services)
  • 3-Urgent: Supports will be needed in the next 3-12 months. (8%)
  • 2-Critical: Supports will be needed in the next 1-2 years. (22%)
  • 1-Planning: Supports will be needed in the next 3-5 years. (23%)
  • 0-Currently no unmet needs (40%)

While the Department will continue to maintain a registry of individuals, today, the registry reflects that those with needs are receiving the services necessary to continue living in a home or community environment. The registry allows the department to plan for and to be responsive to individuals if their needs change, becoming urgent or emergent.

Everyone in Tiers 3 and 4 will be offered the most appropriate services and supports, said Mark Thomas, deputy secretary of LDH.

“The new approach to waiver services allows us to offer community-based services in a manner that will offer coverage to a greater number of individuals, will provide for more predictable budget requests, and in a manner that will be more sustainable for the long-term,” Thomas said.

Prior to this change, it would have cost the state $832 million in new state and federal dollars to address the needs of all of the individuals on the waiting list. However, with this approach, meeting the needs of individuals with disabilities is resolved with a $43 million investment (passed by the Legislature in 2018) which includes state funds and a federal match. 

“This shift to a tiered waiver system will allow Louisiana to meet the needs of more people who require the greatest level of services or supports and, at the same time, be more efficient with state dollars,” Thomas said.

Families and advocates for people with disabilities support the Tiered Waiver.

Sandee Winchell, executive director of the Louisiana Developmental Disabilities Council, said assessing the needs of individuals with developmental disabilities gave the state the data to support making this change.

“The type and urgency of needs of people who have been waiting for services are now known,” Winchell said. “The state can now better project the dollar amounts necessary to meet the needs of these individuals and direct resources to where they are most needed.”

For additional information or frequently asked questions regarding Tiered Waivers, click here.


About the Louisiana Department of Health 


The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state residents. The Louisiana Department of Health includes the Office of Public Health, Office of Aging & Adult Services, Office of Behavioral Health, Office for Citizens with Developmental Disabilities, and Healthy Louisiana (Medicaid). To learn visit or follow us on TwitterFacebook, or our blog.