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 Sep 4, 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
- How CCW Offers Are Made
- 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 Sep 4, 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. 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 you get in only by receiving an offer of services, which the Louisiana Department of Health (LDH) makes in a set order.
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 Sep 4, 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 Sep 4, 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. Our guide to whether Medicaid pays for 24-hour home care explains how hour limits work in other states.
Do You Qualify for a Louisiana Medicaid HCBS Waiver?
LDH lists three CCW requirements, and every one has to be met: you must qualify for long-term care Medicaid, be age 21 or older, and meet a nursing-home level of care.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Long-term care Medicaid has its own list, and it is all-or-nothing too. Besides the care-need and money rules below, it requires Louisiana residency, U.S. citizenship or lawfully admitted non-citizen status no longer subject to the five-year waiting period, a Social Security number (or an application for one), and an offer of home and community-based services. You also have to fall into an eligible group, which for an adult needing long-term care means being 65 or older, blind, or disabled under the Social Security Administration's definition.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
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 Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
The money rules. LDH says the Medicaid financial requirements for a waiver like the CCW are the same as for nursing-facility care.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Two limits apply:
- Income. Your countable monthly income has to be at or below three times the monthly Supplemental Security Income (SSI) federal benefit rate. If your income is above that line, you may still qualify when you have enough medical expenses to spend down to it.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 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 Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA If you are married and your spouse lives at home, a separate, higher resource ceiling applies to you, and spousal impoverishment rules protect part of the couple's countable resources for the spouse at home.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 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 Sep 4, 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, medical supplies, and assistive technology
- A personal emergency response system (PERS), the wearable button that calls for help
- Financial management services, meaning help with hiring workers and with payroll
- Permanent supportive housing, meaning help getting a house or apartment
For someone who is already in a nursing home, LDH also lists two services for moving out: transition intensive support coordination, where a support coordinator helps you leave the nursing home, and a transition service that pays for items you need when you move.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
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 Sep 4, 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.
How CCW Offers Are Made
Applying alone does not get you into the Community Choices Waiver. Entry is gated by an offer: receiving an offer of home and community-based services is itself one of the eligibility requirements, and LDH makes those offers 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 Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Here is how that order works. LDH lists six groups of people who are offered CCW opportunities, among them people referred by protective services after abuse or neglect, people diagnosed with amyotrophic lateral sclerosis (ALS), people living in or linked to a State of Louisiana Permanent Supportive Housing unit, and nursing-home residents whose only payer is Medicaid. Everyone else gets an offer on a first-come, first-served basis, based on 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 Sep 4, 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 asked. If you think your relative will need the waiver, asking sooner protects their position even if the need is not urgent yet.
How to Apply
Applying for the CCW involves two connected steps: asking for waiver services, which sets your date for an offer, and applying for long-term care Medicaid. You can start them together.
Ask for services. To request Community Choices Waiver services, families contact Louisiana Options in Long Term-Care at 1-877-456-1146 (TTY 7-1-1).Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
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, federal rules cap how long the state may take to decide. A Medicaid agency generally may take no more than 45 days, or no more than 90 days for applicants who apply for Medicaid on the basis of disability.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 Those are limits on the agency, not a promise your answer will arrive that fast, and which one applies turns on the basis you applied under rather than on whether a disability question comes up along the way: an older adult applying on the basis of age for waiver coverage falls under the 45-day limit even when the case includes a level-of-care assessment. Keep in mind that meeting the money and care-need rules is not the same as getting into the waiver: an offer of services is one of the requirements, so you can meet the rest and still be waiting for a CCW offer.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
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, much of a resident's monthly income goes toward the cost of care, but not all of it: federal rules require the state to let the resident keep a personal needs allowance (PNA) of at least $30 a month for personal expenses, and other amounts are deducted too, such as an allowance for a spouse at home and amounts for medical costs insurance does not cover.U.S. Government Publishing Office. (2024). 42 U.S.C. 1396a(q) — Minimum monthly personal needs allowance deduction (govinfo.gov, United States Code, 2024 Edition). govinfo.gov. Retrieved Oct 13, 2026, from https://www.govinfo.gov/content/pkg/USCODE-2024-title42/html/USCODE-2024-title42-chap7-subchapXIX-sec1396a.htm 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 Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
If I meet the money rules, why might I still be waiting for services?
Because the money and care-need rules are not the whole test. LDH's list of requirements for long-term care Medicaid includes receiving an offer of home and community-based services, and CCW offers go to six listed groups and then to everyone else by the date they asked for services. That is why someone can clear the income, resource and care-need rules and still be waiting for a CCW offer.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Does the CCW help if I hire my own workers?
Among the waiver's covered services are financial management services, which LDH describes as help with hiring workers and with payroll.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov (CMS) - Louisiana Waiver Factsheet: LA Community Choices (CC) Waiver. medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Ask how that works for your situation when you call Louisiana Options in Long Term-Care.
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