Louisiana Medicaid for seniors and long-term care

Last verified: June 2026

Long-term care eligibility for seniors in Louisiana

Seniors age 65 and older seeking long-term care through Healthy Louisiana must meet both a clinical level-of-care standard and a financial standard. Louisiana uses the same 300% of the SSI Federal Benefit Rate income limit as most states for nursing facility and HCBS waiver coverage — approximately $2,829/month for an individual in 2025.

The countable resource limit for a single individual is generally $2,000. A community spouse may retain a protected resource allowance under federal spousal impoverishment protections. Louisiana's Medicaid program excludes the primary home, one vehicle, household goods, burial funds up to specified limits, and certain other assets from the resource count.

• Must be a Louisiana resident and U.S. citizen or qualified noncitizen
• Must require nursing facility level of care (clinical assessment required)
• Individual income at or below approximately $2,829/month (300% FBR, 2025)
• Countable resources generally at or below $2,000 for a single individual
• Spousal impoverishment protections apply for married applicants

Community Choices Waiver: home care for seniors and disabled adults

The Community Choices Waiver (CCW) 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.

• Personal care assistance (PCA)
• Home health aide visits
• Skilled nursing visits
• Adult day health care
• Respite care for family caregivers
• Homemaker and chore services
• Environmental accessibility modifications (ramps, grab bars)
• Medical equipment and supplies
• Care coordination and case management

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. Contact LDH or your local Aging and Disability Resource Center to begin the application process.

PACE: all-inclusive care for seniors

Louisiana participates in the Program of All-Inclusive Care for the Elderly (PACE). PACE 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 for PACE, 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 — you leave your current managed care plan and receive all services through the PACE organization. Contact LDH for PACE site locations in Louisiana.

Supports Waiver for people with developmental disabilities

Louisiana 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. There is a waiting list for this waiver — contact OCDD at the Louisiana Department of Health to apply.

Estate recovery in Louisiana

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.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Louisiana's share of that population is administered through Louisiana Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

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 (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

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. Not all states allow this; verify whether Louisiana uses this approach with Louisiana Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Louisiana Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Louisiana Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Louisiana Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Louisiana's current CSRA is set by Louisiana Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments