Frequently Asked Questions

Who qualifies for Louisiana Medicaid Long Term Care?

To qualify for coverage, an individual must:

  • Live (or plan to live) in a participating long-term care nursing facility, a state developmental center, or a group or residential home for individuals with developmental disabilities.
  • Already receive SSI or FITAP cash assistance OR meet the following criteria:
  1. Reside in Louisiana
  2. Have or apply for a social security number
  3. Have countable monthly income below 3 times the monthly SSI benefit rate (FBR)
  4. Have countable resources of less than $2,000 for an individual or $3,000 for a couple, minus allowable excursions;
  5. Be a U.S. citizen or an alien legally admitted for permanent residence;

and be:

  1. Pregnant, or
  2. Under age 18, or
  3. At least 65, or
  4. Blind (with corrected vision of 20/200 or less), or
  5. Disabled (as established by receipt of SS Disability benefits or a BHSF Medical Eligibility Determination Team decision).
  • Meet the "level of care" requirement for appropriate placement as determined by the agency's Health Standards Section based on medical data furnished by the admitting physician and facility or provider.

 

Can an individual receive the necessary care at home or in the community?

Individuals who need the type of medical care usually available in facilities but who can be treated successfully and cost-effectively in other settings may be allowed to receive the necessary care at home or in the community.  The Medicaid Program provides this coverage for a limited number of persons who are otherwise eligible for and would require facility placement.  Current Home and Community-Based (Waiver) Services include:

  • Community Choices Waiver
  • Adult Day Health Care
  • Children's Choice
  • New Opportunity Waiver
  • Supports Waiver
  • Residential Options Waiver (ROW)

Requirements for these programs are the same as for nursing facility care with some additional requirements added.  Space for new participants is limited.  Interested persons should contact the Office of Aging and Adult Services at 1.866.783.5553 for specific program information and requirements.

Individuals who are Medicaid eligible can now receive personal care services in their homes even without being in one of the waiver service programs.

How do I get Medicaid?

To get Medicaid, you must answer all of the questions on the application form and give needed proof so we can see if the person who needs long-term care is eligible.  When we get the application, we will see if the income and resource limits and other non-financial requirements are met.  We must also decide if long-term care is medically necessary and if the provider chosen can supply the care that is needed.  This decision is based on medical information given by his or her doctor(s).

How do I begin the application process?

To begin the application process for long-term facility care OR for information about Home and Community-Based Services, call us toll free at 1.877.456.1146 (TDD 1-877-456-1172) Monday through Friday between 6:30 a.m. and 4:30 p.m. Central Time.

If my parent is not able to complete the application process on their own, can I act as their representative?

Yes, with the appropriate documentation that gives you permission to act on behalf of your parent.

What are the income limits?

Effective January 1, 2015 (and continuing through 2016), the income limits are $2,199 for an individual and $4,398 for a couple (if both spouses need long-term care). 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.

How does the Medically Needy Spend-Down Program work?

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.

What is countable income?

Countable income consists of:

  • Unearned income, which includes money received from SSA, pensions, retirement, veteran's benefits, interest income, cash from friends and relatives, and
  • Earned income, which is money received from working.

 

Whose income is counted?

We use only the income of the person who needs long-term care to decide if he or she is eligible.  We determine how much a person who is eligible for facility care must pay toward the cost of this care.  We must use GROSS monthly income and deduct $38.00 for personal needs, the amount paid for some medical services that are not covered by Medicaid, and certain contributions made to a spouse or dependents.  Any remaining income must be paid toward the cost of facility care.

May a person who qualifies give some of his or her income to a spouse and/or children?

Under Spousal Impoverishment rules, a person who qualifies for Medicaid for facility care may give some of his or her income to a legal spouse who lives at home and/or to any children under age 18. There are limits for how much can be given to these dependents. To decide how much can be contributed, we need income information about the spouse and/or children.

How is resource eligibility determined?

Countable resources cannot be worth more than $2,000 for an individual or $3,000 for a couple who needs long-term care.  Under Spousal Impoverishment rules, a couple can have up to $113,640 in countable resources, as long as there is a spouse at home who does not get long-term care.  Resources owned separately, by either spouse, and all resources owned jointly by the couple are used to determine countable couple assets.  Resources owned jointly by the couple, and those in excess of the $2,000 allowed for the long-term care spouse must be transferred to the at-home spouse before the first review of eligibility.  The Spousal Impoverishment resource limit increases each year BUT the limit that applies is the one that was in effect at the time of the most recent admission.

Resources include money plus certain items that are owned by the person who needs long-term care, the legal spouse, or those that are jointly owned.  Resources include cash, financial assets, stocks, savings bonds, land, life insurance, vehicles, and anything else which could be changed to cash.

Financial assets include checking, savings, and credit union accounts; stocks, bonds, certificates of deposit, money market accounts, promissory notes, and safety deposit boxes.  We look at account ownership to determine who has access to the money.  We use the balance as of the first moment of the first day of a month as the value of the asset and to determine asset eligibility for the entire month.  Income that is deposited on or for the first day of the month is not counted as part of the account value for that month.  Funds to cover outstanding checks that have not cleared the bank by close of business on the last day of a month are considered "available" and are used to determine resource eligibility.

Some things usually do not count toward the resource limit, no matter how much they are worth.  Examples of such things are a home and the land it is on, one car, life insurance policies with a combined face value of $10,000 or less, burial plots or spaces, and irrecoverable burial arrangements.

A burial fund is an asset set aside to pay for burial expenses.  In some cases, up to $10,000 of this money will not count as a resource.  Some or all of the money in a burial fund may count toward the resource limit if the person owns life insurance policies or has other burial arrangements.

We must look at any transfer of resources which occurred within the 60 months (60 months for trust situations) before 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 we determine that resources were transferred to qualify for Medicaid, the person who needs long-term care will not be eligible for facility payment for a specified period.  We use the uncompensated value of the transferred item to determine how long the person will be ineligible.

What happens when a long-term care recipient dies?

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 services, hospital care, and prescription drugs the person received at age 55 or older.

How long does an eligibility decision take?

In most cases, we will make an eligibility decision and notify you of our finds 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.

What if there are changes?

Changes must be reported to us within 10 days if the person who gets Medicaid or his/her legal spouse:

  • Has a change in income or resources, including inheritances;
  • Has a change in health insurance coverage or premiums; or
  • Has a change in residence or mailing address.

 

What if I think a decision you make is unfair, incorrect, or made too late?

You or the person who needs long-term care has the right to ask for a Fair Hearing.  You can do this by calling or writing to the local Medicaid office.  You may also write directly to Louisiana Department of Health, Bureau of Appeals at P.O. Box 4183, Baton Rouge, LA 70821-4183.

Where can I find information about a nursing home's health or fire-safety inspection results?

Health and fire-safety inspections with detailed and summary information about deficiencies found during the 3 most recent comprehensive inspections (conducted annually) and the last 3 years of complaint investigations are found on Nursing Home Compare website.

Nursing Home Compare allows consumers to compare information about nursing homes. It contains quality of care information on every Medicare- and Medicaid-certified nursing home in the country, including over 15,000 nationwide.

Note: Nursing homes aren't included on Nursing Home Compare if they aren't Medicare- or Medicaid-certified. These Nursing Homes can be licensed by the state. For information about Louisiana nursing homes not on Nursing Home Compare, or any other nursing home inquiry contact LDH-Health Standards Section, Nursing Home Program Desk, 225-342-0114, or visit the Nursing Home Internet home page.

Nursing Home providers are required to post the results of their most recent inspection in the facility.

What is a Plan of Correction and how do I obtain a copy of one?

Health care providers licensed, by the Louisiana Department of Health (LDH), or certified for participation in Medicaid or Medicare, by the Centers for Medicare and Medicaid Services (CMS), are inspected, or surveyed, periodically by LDH's Health Standards Section (HSS). Life safety code inspections are performed by State Fire Marshals. HSS also performs complaint investigations.

Deficient practices discovered during the inspection or investigation are "cited" on a form called the Statement of Deficiencies, or SOD.

The provider's plan to correct deficient practices is known as the Plan of Correction, or POC.  The plan must be submitted to the state agency, HSS, within 10 calendar days from the date the facility receives the Statement of Deficiencies, or SOD.

To obtain a provider's POC submit a Public Records Request (PRR) to Health Standards Section.

Please visit HSS' Procedure for Public Records Request (PRR) Internet web page to learn what information is required for a Public Records Request.

Click here to learn more about CMS Statement of Deficiencies and Plan of Correction forms.

Contact Health Standards Section at 225-342-0138 for additional information.