Medicaid is a health care program for low-income individuals of all ages. While this program is available to diverse groups of Louisiana residents, this page is focused on Medicaid long term care eligibility for elderly Louisianians, aged 65 and over. In addition to nursing home care coverage, LA Medicaid pays for care services and supports to help frail seniors continue to live at home, in adult foster care, or in assisted living. There are three categories of Medicaid long-term care programs for which Louisiana seniors may be eligible.
1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; there are a limited number of participant enrollment slots and wait lists may exist. Intended to delay and prevent nursing home admissions, services and supports are provided at home, adult day care, adult foster care, or in assisted living. More on Waivers.
3) Regular Medicaid / Aged Blind and Disabled – An entitlement; anyone who meets the requirements will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
Louisiana’s Medicaid program is jointly funded by the state and federal government, but is administered by the state under federally set parameters. The Louisiana Department of Health is the administering agency. Most persons receive their health services via a Managed Care Program called Healthy Louisiana, formerly called Bayou Health.
The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.
Each of the three Medicaid long-term care programs have varying financial and medical (functional) eligibility criteria. Financial requirements change annually, vary based on marital status, and is further complicated due to Louisiana offering alternative pathways towards eligibility.
Simplified Eligibility Criteria: Single Nursing Home Applicant
LA seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $2,829 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Louisiana Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid. More.
| 2024 Louisiana Medicaid Long-Term Care Eligibility for Seniors | |||||||||
| Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) | ||||||
| Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | |
| Institutional / Nursing Home Medicaid | $2,829 / month* | $2,000 | Nursing Home | $5,658 / month* | $3,000 | Nursing Home | $2,829 / month for the applicant* | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
| Medicaid Waivers / Home and Community Based Services | $2,829 / month† | $2,000 | Nursing Home | $5,658 / month† | $3,000 | Nursing Home | $2,829 / month for applicant† | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
| Regular Medicaid / Aged Blind and Disabled | $943 / month | $2,000 | Help with ADLs | $1,415 / month | $3,000 | Help with ADLs | $1,415 / month | $3,000 | Help with ADLs |
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $38 / month, Medicare health premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.
Countable vs. Non-Countable Income
Nearly all income that a Medicaid applicant receives is counted toward the income limit. This includes cash from family and friends, employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in LA, the VA Aid & Attendance, which is above and beyond the Basic VA Pension, does not count as income.
Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is counted. In other words, the non-applicant spouse’s income is disregarded. Additionally, the non-applicant may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse. The MMNA is the minimum amount of monthly income a non-applicant spouse is said to require to prevent spousal impoverishment.
In 2024, the MMNA in LA is $3,853.50 / month. If the non-applicant spouse has monthly income under this amount, income can be transferred to them from their applicant spouse, bringing their income up to this level. A non-applicant spouse who already has $3,853.50 / month or more in income is not entitled to a MMNA / Spousal Income Allowance. The MMNA also effectively lowers the income of the applicant spouse for eligibility purposes.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Minimum Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.
Countable vs. Non-Countable Assets
Countable assets are counted towards the asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Louisiana, IRAs and 401K’s are also counted. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, life insurance policies (combined face value limit of $10,000), and generally one’s primary home.
Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the Medicaid program for which a senior applies and regardless of if one or both spouses are applicants. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for the non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant. In 2024, this allows the non-applicant spouse to keep up to $154,140 of the couple’s assets. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.
Medicaid’s Look-Back Rule
Louisiana has a 60-month Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers that immediately precedes one’s application date. During which, Medicaid checks to ensure no assets were sold or gifted under fair market value. This includes gifts to friends and family, as well as asset transfers made by one’s spouse. The Look-Back Rule is meant to discourage persons from gifting assets in order to meet Medicaid’s asset limit. For persons who violate this rule, a Penalty Period of Medicaid ineligibility is established. The Look-Back Rule does not apply to Regular Medicaid applicants and their spouses.
The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, the Gift Tax Rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.
For the home to be exempt, the Medicaid applicant or their spouse must live in it. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For single seniors applying for Regular Medicaid, there is no home equity interest limit. Other exemptions exist.
The home is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Louisiana’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.
An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, additional eligibility criteria may need to be met for some program benefits. For example, for a personal emergency response system, an inability to safely live at home without it may be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living is required, but a NFLOC is not necessarily required.
Louisiana elderly residents (aged 65 and over) who do not meet the financial eligibility requirements above, can qualify for Medicaid in other ways.
1) Medically Needy Pathway – Louisiana has a Medically Needy Program (MNP), also called a “Spend-Down” program, for seniors who have income over Medicaid’s income limit. This program allows persons with high medical bills relative to their monthly income to become income-eligible by spending “excess” income on medical expenses (i.e., those not covered by a third party and health insurance premiums). Specific to Nursing Home Medicaid and Medicaid Waivers, the cost for nursing home care and home and community based services can be used to reduce one’s “excess” income.
In 2024, LA’s Medically Needy Income Eligibility Standard (MNIES) is $100 / month for an individual and $192 / month for a couple living in an urban area (East Baton Rouge, Jefferson, Orleans, and St. Bernard Parishes). In rural areas, the MNIES is $92 / month for an individual and $167 / month for couples. One’s “spend down” amount, which can be thought of as a deductible, is the difference between their monthly income and the MNIES. Note that Waiver beneficiaries can retain a Basic Needs Allowance of $2,829 / month.
In LA, the “spend down” is calculated for a 3-month period. Once one’s “spend down” has been met, they will be income-eligible for Medicaid benefits for the remainder of the period. The Medically Needy Asset Limit is $2,000 for an individual and $3,000 for a couple.
2) Asset Spend Down – Applicants who have assets over Medicaid’s limit can still become asset-eligible by “spending down” assets on non-countable ones. One way to do this is to make home modifications, such as adding wheelchair ramps or stair lifts, widening doorways for wheelchair access, and adding a first floor bedroom and / or bathroom. One can also prepay funeral / burial expenses and pay off existing debt, such as one’s mortgage. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s “Look-Back” Period” and can result in a Penalty Period of Medicaid ineligibility. When “spending down”, it is best to keep documentation of how assets were spent as evidence the Look-Back Period was not violated.
Our Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible and to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.
In addition to paying for nursing home care, Louisiana Medicaid offers the following programs relevant to the elderly that helps them to live at home, in adult foster care homes, or in assisted living residences.
1) Adult Day Care Waiver – Also called the Adult Day Health Care (ADHC) Waiver, this program provides adult day care for Louisiana residents who are elderly or disabled.
2) LT-PCS Program – The Long Term – Personal Care Services Program is an entitlement program through the state Medicaid plan. Assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as bathing, grooming, mobility, eating, laundry, and shopping for essentials, is provided in one’s home.
3) Community Choices Waiver (CCW) – Intended for adults with physical disabilities and seniors who would require nursing home placement if not for the services available via this program. Benefits, such as respite care, adult day care, temporary skilled nursing, and assistive devices is available to those residing at home, in assisted living, or adult foster care.
4) Program of All-Inclusive Care for the Elderly (PACE) – Through PACE, the benefits of Medicare and Medicaid, including long-term care, are available via one program.
5) Money Follows the Person (MFP) – Also called My Place Louisiana in LA. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
Persons can apply for Medicaid in Louisiana online at LA Medicaid / LaCHIP – Self Service Portal, by calling Medicaid Customer Service at 1-888-342-6207, or in person at a Medicaid Application Center. Walk-in applications are not accepted at all Application Centers. Persons should first contact their local center. One’s local Area Agency on Aging office office can provide application assistance. The application process may vary based on the program for which one is applying.
Prior to applying for Medicaid, it is imperative that Louisiana seniors be certain all eligibility requirements discussed above are met. If one is over the income and / or asset limit(s), or are unsure if they meet the eligibility criteria, Medicaid Planning can be invaluable. The application process, which can be lengthy, is also complicated. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.