Louisiana Medicaid Long Term Care Eligibility
Louisiana Long Term Care
Louisiana is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application. Louisiana does, however, have a medically needy program for certain cases, which can cover long-term care even if the income limit is exceeded. Basically, individuals 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.
Louisiana’s Medicaid Program provides payment for special long-term care support services, as well as full Medicaid health coverage, to eligible people who, because of their medical conditions, require assistance with activities of daily living (eating, bathing, dressing, grooming, transferring, etc.). Long-term care supports may be provided either in a facility or in an individual’s home.
1. Residency and Citizenship – the applicant must be a resident of Louisiana and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
3. Income Limitations – If single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $2,313 to become eligible for Medicaid. Income that is not considered countable includes a personal needs allowance ($38.00/month per individual). If the applicant receives a veteran’s pension they can keep $90 per month in addition to the $38 personal needs allowance.
- Louisiana only uses the income of the person who is applying for long-term care when determining eligibility. On a case by case basis, the state determines how much an eligible individual must pay toward the cost of care. To find a total countable amount, Louisiana uses GROSS monthly income, the amount paid for some medical services that are not covered by Medicaid, and certain payments made to a spouse or dependents. Remaining income must be used towards the cost of care.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Louisiana include:
i. $2,000 or less in cash/non-exempt assets if single. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
ii. One home is exempt (equity limit $585,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Burial spaces/plots and irrevocable burial funds, with a value of $10,000 or less, varying by case. If the recipient has a life insurance policy which includes burial arrangements then some or all of the money in burial spaces and burial trusts may become a countable resource.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. Value of life insurance if face value is $10,000 or less.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $126,420. If the community spouse’s assets do not equal $126,420, the community spouse is able to retain assets from the institutionalized spouse until the amount is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse. The maximum amount of income that can be retained is $3,160.50/month.
Louisiana long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
More information on the Louisiana partnership program: http://www.ldi.louisiana.gov/docs/default-source/documents/publicaffairs/consumerpublications/ltc-partnership-program.pdf?sfvrsn=9
To begin the application process for long-term facility care OR for more information about Home and Community-Based Services, call 1.877.456.1146 Monday through Friday between 6:30 a.m. and 4:30 p.m. Central Time.
Department of Health—Medicaid long term care frequently asked questions: http://dhh.louisiana.gov/index.cfm/faq/category/24