In Louisiana, Medicaid pays for long-term care at home mainly through one program, the Community Choices Waiver (CCW), for people who would otherwise need a nursing facility. The CCW is Louisiana's main Medicaid home and community-based services (HCBS) waiver, one of the Louisiana Medicaid HCBS waivers run by the Louisiana Department of Health through its Office of Aging and Adult Services (OAAS). Medicaid covers those services for people who need a nursing-facility level of care and qualify for long-term care Medicaid.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
In This Guide
- What Louisiana Medicaid HCBS Waivers Are
- The Community Choices Waiver, Louisiana's Main HCBS Path
- Do You Qualify for a Louisiana Medicaid HCBS Waiver?
- What the Community Choices Waiver Covers
- The CCW Interest List and How Enrollment Works
- How to Apply
What Louisiana Medicaid HCBS Waivers Are
Home and community-based services, or HCBS, is the umbrella term for long-term care that Medicaid delivers in your own home or community instead of inside a nursing facility. Federal law gives states the option to run these programs under a Section 1915(c) waiver, which lets a state waive some of the usual Medicaid rules so it can pay for in-home supports for people who would otherwise qualify for institutional care.
Louisiana uses that authority to run the Community Choices Waiver (CCW), its primary HCBS waiver for older adults and adults with physical disabilities.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA The idea behind the waiver is straightforward: rather than paying for a nursing-home bed, Medicaid pays for the personal care, coordination, and home supports that let someone remain safely at home. Because it runs under the 1915(c) authority, CCW comes with two features worth understanding up front, which the sections below cover: it is limited to people who meet a nursing-facility level of care, and the number of people it can serve is capped, so there is a request list.
The Community Choices Waiver, Louisiana's Main HCBS Path
The Community Choices Waiver is administered by the Office of Aging and Adult Services (OAAS), a division of the Louisiana Department of Health.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA It serves two groups of adults who want to receive care at home: people age 65 or older, and adults with physical disabilities between the ages of 21 and 64. In both cases the person must need the kind of care a nursing facility would provide and must qualify for long-term care Medicaid.
One point is important to set expectations honestly. The CCW is designed to supplement the care a family and community already provide, not to replace it around the clock. The program by itself does not provide help 24 hours a day.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Families often combine the waiver's paid services with their own caregiving and other community resources to build a full week of coverage. If your relative needs constant supervision, it is worth thinking through how the waiver's hours fit alongside the rest of the day before you plan around it.
Do You Qualify for a Louisiana Medicaid HCBS Waiver?
Qualifying for the CCW means clearing two separate tests: a health, or functional, test and a financial test. You have to pass both.
The functional test. You must meet a nursing-facility level of care, meaning your needs are serious enough that you could be cared for in a nursing home. For the CCW, that determination is made by OAAS, or in some cases by the state office that handles developmental-disability services.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
The financial test. CCW applicants have to qualify for long-term care Medicaid, which uses Louisiana's long-term care financial rules. There are two parts:
- Income. Your countable monthly income has to be at or below 300% of the monthly Supplemental Security Income (SSI) federal benefit rate. If your income is above that line, you may still qualify through a spend-down path when you have enough medical expenses to bring countable income down.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
- Resources. Your countable resources have to be at or below $2,000 for an individual, or $3,000 for a married couple who both live in the same facility.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Because the money rules for long-term care Medicaid have their own detail, from what counts as a resource to how a spouse's income and assets are treated, it is worth reading our guides on Louisiana Medicaid income and asset limits and Louisiana Medicaid spousal impoverishment rules alongside this one.
What the Community Choices Waiver Covers
The CCW pays for a range of services meant to keep someone safe and supported at home. Covered services include:Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
- Support coordination (case management to organize and monitor your care)
- Personal assistance and personal care with basic self-care such as bathing, dressing, and eating
- Adult day health care at a community center
- Nursing and skilled therapy services
- Home-delivered meals
- Caregiver temporary support (respite), which gives a family caregiver a break
- Monitored in-home caregiving
- Environmental accessibility adaptations, meaning home modifications such as ramps and grab bars
- Assistive devices and technology
- A personal emergency response system (PERS), the wearable button that calls for help
- Financial management services for people who direct their own workers
The one boundary to keep in mind is the one noted earlier: the waiver by itself does not provide help 24 hours a day.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA It fills in specific supports, and families layer those on top of their own caregiving.
The CCW Interest List and How Enrollment Works
Meeting every requirement does not automatically get you a spot. The Community Choices Waiver is not an open entitlement, which means Louisiana funds a limited number of slots and offers them in a set order.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Here is how that order works. Openings are offered first to defined priority groups, for example people referred by protective services, people with amyotrophic lateral sclerosis (ALS), and nursing-home residents whose only payer is Medicaid. After those groups, everyone else receives an offer on a first-come, first-served basis, ordered by the date they asked for services.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA That date-you-asked timing is the practical reason to request services as early as you can: your place in line is set by when you first reached out, not by when a slot happens to open. If you think your relative will need the waiver, getting on the request list sooner protects their position even if the need is not urgent yet.
How to Apply
Applying for the CCW involves two connected steps: getting on the request list for the waiver, and qualifying for long-term care Medicaid on the money side. You can start them together.
Get on the request list. To ask about the Community Choices Waiver or get on the list, families contact Louisiana Options in Long Term-Care at 1-877-456-1146 (TTY 711).Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA This is the intake line the Office of Aging and Adult Services uses to take requests and start the level-of-care process.
Apply for long-term care Medicaid. Federal rules require the state to let you apply for Medicaid through several channels, so you can apply online, by phone, by mail, or in person.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Our guide on how to apply for Louisiana Medicaid walks through the documents you will need and where to send them.
Once you apply, the state has a deadline to decide. Under federal rules, a Medicaid agency generally must decide an application within 45 calendar days, or within 90 calendar days when eligibility is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf Keep in mind that clearing the financial determination and getting an actual waiver slot are two different things: you can be approved for long-term care Medicaid and still be waiting for a CCW opening to be offered.
Frequently Asked Questions
What is the difference between the Community Choices Waiver and a nursing home?
Both are paid by Medicaid for people who need a nursing-facility level of care, but they deliver that care in different places. The Community Choices Waiver (CCW) pays for services in your own home so you can stay in the community, while a nursing home provides care in a facility. There is also a money difference worth knowing. In a nursing facility, most of a resident's monthly income goes toward the cost of care, and federal rules let the resident keep only a small personal needs allowance (PNA) of at least $30 a month for personal expenses.U.S. Government Publishing Office. (n.d.). 42 U.S.C. 1396a(q)(2) — Minimum monthly personal needs allowance deduction (govinfo.gov USCODE). govinfo.gov. Retrieved Jun 24, 2026, from https://www.govinfo.gov/link/uscode/42/1396a A waiver lets a person keep living at home instead, which many families prefer when it is safe and workable.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
If I already qualify for Medicaid, why might I still be waiting for services?
Because two separate approvals have to line up. Passing the long-term care Medicaid financial review makes you eligible, but the Community Choices Waiver is not an open entitlement. It funds only a limited number of slots, so you also have to be offered one. That is why someone can be approved for long-term care Medicaid and still be waiting for a CCW opening to be offered.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Can I hire and direct my own workers under the CCW?
The waiver includes self-direction. Among its covered services are financial management services for people who direct their own workers, which means the CCW supports an arrangement where you help manage your own care rather than relying only on an agency.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA The details of who you can hire and how the budget works are set by OAAS, so ask about self-direction when you call the intake line.
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