Jeffrey Wade
Medicaid is a healthcare program for low-income individuals of all ages, and it covers many of the same services that private health insurance covers. In Louisiana, Medicaid covers services like chemotherapy, mental health rehabilitation, and meals and lodging for trips. It also offers special benefits for children and youth with developmental disabilities. Louisiana also has a Medically Needy Program (MNP) for seniors with income over Medicaid's limit, allowing them to become eligible by spending excess income on medical expenses. So, can you have both Medicaid and private insurance in Louisiana?
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What You'll Learn
Medicaid covers meals and travel
In Louisiana, Medicaid covers meals, lodging, and travel expenses for the beneficiary and one attendant when long-distance travel is required. Long-distance travel is defined as when the total travel time, including the duration of the appointment and the travel to and from the appointment, exceeds 12 hours. This means that if a beneficiary needs to travel a long distance for medical care, they can have their meals and accommodation covered by Medicaid.
Medicaid in Louisiana also provides coverage for various health services, including chemotherapy administration and treatment drugs as prescribed by a physician. Additionally, adult behavioral health services are covered, such as Community Psychiatric Support and Treatment (CPST), Psychosocial Rehabilitation (PSR), and Crisis Intervention (CI). There are also special benefits for children and youth with developmental disabilities.
For those enrolled in the Louisiana Community Choices Waiver program, there is the option of receiving home-delivered meals through Mom's Meals. This service provides meals based on individual preferences and needs, ensuring a variety of nutritious and delicious options. The initial deliveries from Mom's Meals offer a range of meals catering to different dietary preferences.
It is important to note that some services covered by Medicaid in Louisiana may have limitations or require prior authorization. This means that Medicaid must agree to pay for the service before it is offered to the patient. Beneficiaries should always check with their doctor or provider about any restrictions on receiving specific services.
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Income and asset limits
For 2025, Louisiana has set an income cap for Medicaid long-term care benefits. This means applicants must be below the income limit at the time of application. For single nursing home applicants, the income limit is $2,901 per month. If the applicant is married, the income of both spouses is calculated towards the applicant's income eligibility. The community spouse may retain assets up to $152,020, and a portion of the institutionalized spouse's income, up to a maximum of $3,898.50 per month.
Louisiana categorizes assets as either exempt or non-exempt. Non-exempt assets must be liquidated and used to cover care costs before Medicaid eligibility. Exempt assets include personal belongings, household furnishings, an automobile, burial trusts, and life insurance policies (with a combined face value limit of $10,000). One home is also exempt if the applicant plans to return, or a spouse, child under 21, or disabled person lives there. The value of the applicant's countable assets must be $2,000 or less.
Louisiana enforces a 5-year look-back period, during which the sale of assets below fair market value or the gifting of resources will be penalized. To be eligible for Medicaid, assets equivalent to the benefits paid out by long-term care insurance policies must be protected. Each spouse must purchase individual policies for protection.
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Special benefits for children with disabilities
In Louisiana, there are several benefits available to children and youth with disabilities who are under the age of 21 and have a medical need for the service. These include:
Medicaid Home and Community-Based Services Waivers
- Louisiana Children's Choice Waiver: This waiver provides services to children with disabilities who live with their families or are leaving an institutional setting to return to their family home. It offers a specified monetary amount in support services, including support coordination, family support, and family training. Children remain eligible for this waiver until their 20th birthday.
- New Opportunities Waiver (NOW): This waiver provides services to individuals with intellectual and/or other developmental disabilities. It covers family support, center-based respite, environmental accessibility modifications, and specialized medical equipment and supplies. NOW also assists with employment and professional and nursing services beyond those typically covered by Medicaid.
- Supports Waiver: This waiver provides specific, activity-focused services rather than continuous custodial care. It offers supported employment, day habilitation, prevocational services, respite, habilitation, permanent supportive housing stabilization, and personal emergency response systems.
- Residential Options Waiver (ROW): This waiver is for individuals whose health and welfare can be assured by a support plan, with a cost limit based on their level of support need. It offers community living supports, companion care, environmental modifications, assistive technology/specialized medical equipment, personal emergency response systems, and respite.
Mental Health and Behavioral Services
Children and youth with mental illness may receive Mental Health Rehabilitation Services, including clinical and medication management, individual and family intervention, counseling, psychosocial skills training, and behavior intervention plan development. Psychological and behavioral services are also available from licensed psychologists and may include assessments, evaluations, individual therapy, and family therapy.
Personal Care Services (PCS)
PCS are provided by attendants when physical limitations due to illness or injury require assistance with activities of daily living, such as eating, bathing, dressing, and personal hygiene.
Extended Nursing Services
Children with disabilities may be eligible to receive Extended Nursing Services in their homes, provided by a Home Health Agency and ordered by a physician.
Medical Equipment and Supplies
Children can obtain any medically necessary medical supplies, equipment, and appliances needed to correct or improve physical or mental conditions.
Transportation
Medicaid provides transportation to and from medical appointments, regardless of whether the appointment is with a Medicaid provider.
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Mental health services
Mental health and substance use treatment are important parts of healthcare in Louisiana. Louisiana Healthcare Connections offers health insurance plans with comprehensive healthcare services that cater to the needs of families and individuals. Members with mental health or substance use issues may talk to one of their licensed counselors anytime. These counselors can provide counseling in a person's home, work, or school.
Louisiana's Medicaid program covers many of the same things that private health insurance programs traditionally cover. Medicaid can also cover services to help "fill in the gaps" in Medicare and meet certain long-term care needs. AmeriHealth Caritas Louisiana is a Medicaid managed care plan that serves Louisiana citizens. They offer mental health and substance use treatment services. Members under the age of 21 are eligible for ABA services. Adults eligible to receive mental health rehabilitation services under the Medicaid State Plan include those who meet specific criteria, such as having a rating of three or greater on the functional status domain on the level of care utilization system (LOCUS).
Louisiana Healthcare Connections also provides a 24/7 Crisis Hotline for those experiencing a severe mental health problem or crisis. A crisis counselor will work with the individual, their family, and their provider to help them get the care they need. The Louisiana Department of Health/Office of Behavioral Health (LDH/OBH) has created the Louisiana Crisis Response System, which provides services such as mobile crisis response, community brief crisis support, behavioral health crisis centers, and crisis stabilization.
For those with a job, an Employee Assistance Program (EAP) is a free and confidential service that companies offer. This service can help employees with mental health, drug or alcohol use, grief, and trauma. Students can also look for their school's health center or peer support group.
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Long-term care
Louisiana's Medicaid program offers payment for long-term care support services, including full Medicaid health coverage, to eligible individuals requiring assistance with activities of daily living (ADLs) such as eating, bathing, dressing, and grooming. Services may be provided in a facility or at home.
Eligibility Criteria
To be eligible for long-term care Medicaid in Louisiana, applicants must meet specific income and asset limits. Louisiana is an income cap state, meaning there is a hard income limit for Medicaid long-term care benefits. Applicants must fall below the income limit at the time of application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance, and quarterly statements for all bank accounts, retirement accounts, and investments.
The specific eligibility criteria for a single nursing home applicant in Louisiana are as follows:
- Income under $2,901 per month
- Assets under $2,000
- Require a Nursing Home Level of Care
Asset Limitations
Assets are categorized as Exempt or Available. Non-exempt assets must be liquidated and applied toward care costs before Medicaid eligibility. Louisiana enforces a 5-year look-back period, penalizing the sale of assets below fair market value or gifting of resources. Exempt assets include:
- One home if the equity is ≤ $788,000, the applicant plans to return, or a spouse, child under 21, or disabled person resides in it
- One automobile, regardless of equity
- Burial spaces and irrevocable burial funds worth ≤ $10,000
- Personal property, household furnishings, clothing, jewelry, and other non-saleable items
- Life insurance with a face value ≤ $10,000
Louisiana offers several long-term care options for eligible individuals:
- Institutional / Nursing Home Medicaid: An entitlement, meaning anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
- 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.
- Money Follows the Person (MFP): This program helps eligible individuals transition from a nursing home back to the community by providing assistance with moving expenses and long-term care in the new residence.
- Louisiana Long-Term Care Partnership Program: This program helps residents protect their assets from the high costs of long-term health care. It allows individuals to access long-term care Medicaid services without the usual spend-down requirements by purchasing qualified private long-term care insurance policies.
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Frequently asked questions
Yes, you can have both Medicaid and private insurance in Louisiana. Medicaid can help "fill in the gaps" in private insurance and meet certain long-term care needs.
Medicaid covers many of the same things that private health insurance programs traditionally cover. This includes chemotherapy administration and treatment drugs, as well as meals and lodging for trips that are not otherwise covered. There are also special benefits for children and youth with developmental disabilities.
Medicaid is a healthcare program for low-income individuals of all ages. Eligibility criteria include having income and assets under a certain threshold, which varies depending on factors such as marital status, age, and living arrangements.
