The question comes up in almost every first phone call I take. Usually not right away — families start by telling me about their mother, or their son, or the fall last month. Then there’s a pause, and someone finally asks it:
“Miss Stephanie, how are we supposed to pay for this?”
It’s a fair question, and I want to answer it honestly. Paying for in-home care in Louisiana is not simple. But it is not a mystery either. There is a system, it has rules, and once you understand the rules you can work within them.
I’ve been doing this work for more than twenty years out of Metairie, serving families across Jefferson Parish, Orleans Parish, and the surrounding communities. In that time I’ve watched too many families assume they couldn’t afford help — when a program they qualified for was sitting right there.
So let’s walk through it together.
The Four Ways Louisiana Families Pay for In-Home Care
Nearly every family I meet pays for care through one of these four paths, or a combination of them:
- Medicaid State Plan services — mainly Long Term-Personal Care Services (LT-PCS) for adults, and EPSDT services for children
- Medicaid waiver programs — the Community Choices Waiver, the New Opportunities Waiver, the Residential Options Waiver, and Children’s Choice
- Private pay — paying directly, often while a Medicaid application is pending
- Other coverage — long-term care insurance, VA benefits, or Medicare for short-term skilled care
Most people have heard of “the waiver.” Far fewer know that some Louisiana programs have no waiting list at all. That distinction matters enormously, so let’s start there.
Path 1: Long Term-Personal Care Services (LT-PCS) — No Waiting List
If there’s one thing I wish more families in Greater New Orleans knew, it’s this: LT-PCS is not a waiver. It’s a Medicaid State Plan service. That means if you meet the criteria, you receive it. You don’t wait years for a slot to open.
LT-PCS pays for hands-on help with the activities of daily living — bathing, dressing, eating, toileting, getting in and out of bed, moving around the home. It can also cover light housekeeping, meal preparation, laundry, grocery shopping, medication reminders, and help arranging medical transportation.
Who Qualifies for LT-PCS
According to the Louisiana Department of Health, a person must:
- Receive Medicaid benefits, and
- Be 21 years of age or older, and
- Qualify for nursing home level of care, and
- Need at least limited assistance with one activity of daily living, and
- Be able to direct their own care, either independently or through a responsible representative
And meet at least one of these:
- Be in a nursing facility and able to be discharged if community-based services were available, or
- Be likely to require nursing facility admission within the next 120 days, or
- Have a primary caregiver who has a disability or who is at least 70 years old
That last condition is the one families miss. If you are 72 years old and caring for your husband, that alone may open the door.
What LT-PCS Does Not Cover
I want to be straight with you about the limits. LT-PCS does not provide 24-hour support. It does not cover nursing care, medication administration, therapy, companionship, or sitter services. It also will not pay for help that a family member is already providing for free.
To start: call Louisiana Options in Long Term Care at 1-877-456-1146 (TTY 7-1-1).
Path 2: The Community Choices Waiver (CCW) — For Older Adults
The Community Choices Waiver serves adults 21 and older who are aging or have an adult-onset disability and who meet nursing home level of care. It’s broader than LT-PCS, and for many families it’s the difference between staying home and moving into a facility.
CCW can cover support coordination, personal assistance, adult day health care, home-delivered meals (up to two a day), a personal emergency response button, home modifications like ramps and grab bars, assistive technology, nursing and therapy services, and caregiver temporary support — which is respite, plainly named.
The Part Most Families Don’t Know
CCW opportunities are offered in a priority order set by the state. Certain situations move ahead of the general line — including people referred by protective services, people diagnosed with ALS, people in Permanent Supportive Housing, people living in a nursing home on Medicaid, and people already approved for 32 hours of LT-PCS who would otherwise require nursing home placement.
Read that last one again. Getting established on LT-PCS is not only help today. It can also be the doorway to an expedited waiver offer tomorrow. Everyone else receives an offer first-come, first-served based on the date they asked for services.
Which brings me to the single most important sentence in this article.
Ask for Services Now, Even If You’re Not Ready
For Louisiana’s developmental disability waivers — the New Opportunities Waiver (NOW), the Residential Options Waiver (ROW), the Supports Waiver, and Children’s Choice — your place in line is set by the date you asked to be added to the Request for Services Registry (RFSR).
Not the date you needed services. The date you asked.
Thousands of Louisiana families are on that registry. When a person is added, they’re screened for urgency of need, and offers go to people in the highest urgency category with the earliest registry date. So both things matter: how urgent your situation is, and how long you’ve been waiting.
I’ve sat with mothers who told me, “We were managing fine back then, so we didn’t call.” And now they’re managing much less fine, and they’re starting from today’s date instead of a date five years ago.
Please hear me on this. If you have a child or an adult loved one with a developmental disability in Jefferson Parish, Orleans Parish, or anywhere in Louisiana, ask to be added to the registry now. It costs you nothing. It obligates you to nothing. If a slot is offered and you don’t need it yet, you can talk through your options then.
Our step-by-step guide to applying for Medicaid waiver services in Louisiana walks through exactly how to make that request, and our guide to the NOW Waiver covers what that particular program provides.
Path 3: EPSDT — For Children Under 21
If your child is under 21 and has Medicaid, EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) is a separate route that many families overlook while they’re waiting on a waiver.
EPSDT can cover medically necessary personal care services for children — meaning support can begin well before a Children’s Choice Waiver slot ever comes open. Children who do receive the Children’s Choice Waiver may access EPSDT services as well.
If this is your situation, read our guide on getting in-home support for a child with disabilities in Louisiana. The short version: having a child on a waiting list does not mean you have to wait for everything.
Path 4: Private Pay
Some families choose to pay privately. Usually it’s one of three situations: a Medicaid application is pending and help is needed today; the need is limited to a few hours a week; or income and assets fall outside the Medicaid limits.
At AAA Care we offer private pay for personal care assistance — dressing, meal preparation, feeding, bathing and hygiene, mobility and transfer support, ambulation, and routine daily living assistance.
I’ll also say this plainly: private pay is often a bridge, not a permanent plan. If you’re paying out of pocket while an application works its way through, that’s a reasonable season. If you’re paying out of pocket indefinitely because no one ever told you what you might qualify for, that’s a problem we can help you look at.
Sorting Out What Applies to Your Family
Here’s the order I’d suggest working through it:
Does your loved one have Medicaid? If not, that’s step one. Long-term care Medicaid has its own income and asset rules, and they change from year to year — check current figures with Louisiana Medicaid rather than relying on any website’s numbers, including ours.
Are they 21 or older? If yes, LT-PCS and the Community Choices Waiver are the primary paths. If under 21, look at EPSDT and Children’s Choice.
Is there a developmental disability? If yes, get on the Request for Services Registry today, regardless of what else you pursue.
Is the need urgent right now? Then LT-PCS, EPSDT, or private pay are your fastest routes while longer-term applications are pending.
Is there a caregiver in the home who is 70 or older, or who has a disability? That may qualify your loved one for LT-PCS on its own.
Yes, the Paperwork Is a Lot. That’s Part of What We Do.
I’m not going to pretend the applications are easy. Assessments, forms, level-of-care determinations, freedom-of-choice paperwork, support coordination — it’s a great deal to hold while you’re also caring for someone you love and, in most cases, working a job.
That’s exactly why we walk families through it. After twenty-two years, we know which questions get asked, which documents get requested, and where applications tend to stall. You don’t have to figure this out by yourself.
And if you’re already stretched thin, please read our guide to caregiver burnout in Louisiana. Getting help is not giving up.
Frequently Asked Questions
Does Medicaid pay for in-home care in Louisiana?
Yes. Louisiana Medicaid pays for in-home care through several routes — most commonly Long Term-Personal Care Services (LT-PCS) for adults 21 and over, EPSDT services for children under 21, and home and community-based waiver programs such as the Community Choices Waiver, the New Opportunities Waiver, the Residential Options Waiver, and Children’s Choice.
How long is the waiting list for a Medicaid waiver in Louisiana?
For developmental disability waivers, waits have historically been measured in years, and thousands of Louisiana families are currently on the Request for Services Registry. Offers are based on urgency of need combined with the date a person was added to the registry — which is why asking to be added as early as possible matters so much.
Is there any Medicaid home care program in Louisiana without a waiting list?
Yes. Long Term-Personal Care Services (LT-PCS) is a Medicaid State Plan service rather than a waiver, so it does not operate from a waiting list. If a person meets the eligibility criteria, services are available.
Can I be paid to care for my own family member in Louisiana?
In some circumstances, yes. Certain Louisiana Medicaid programs include arrangements in which a caregiver living in the home is compensated, and some programs offer self-direction options. The rules are specific and depend on the program and the family relationship. Call us and we’ll walk through your situation.
What if my loved one doesn’t qualify for Medicaid?
Private pay services are available, and some families also use long-term care insurance or VA benefits. It’s still worth having someone review the Medicaid rules with you, because eligibility for long-term care Medicaid works differently than most people expect.
How do I start?
Call Louisiana Options in Long Term Care at 1-877-456-1146 for LT-PCS and Community Choices Waiver questions. For developmental disability waivers, contact your local human services authority to request placement on the Request for Services Registry. Or call us at (504) 482-1700 and we’ll help you figure out which door you’re standing in front of.
How AAA Care Helps
For more than twenty-two years, AAA Care, LLC has provided community-based services to individuals with disabilities and older adults across Metairie, New Orleans, Kenner, and the surrounding parishes. We serve families through the NOW Waiver (IFS Day and Night), the Residential Options Waiver, Community Choice, Children’s Choice, Respite, Supervised Independent Living, EPSDT, and Long Term-Personal Care Services — along with private pay options and transportation.
We do this work because we believe every person deserves to live with dignity, in their own home and their own community, for as long as it is possible to do so. Independence doesn’t mean doing everything alone. It means having the right support in place.
If you’re not sure where your family fits, call us. There’s no charge for a conversation, and you’ll hang up knowing more than when you dialed.
📞 (504) 482-1700
📧 careteam@aaacareagency.com
🌐 Contact AAA Care
📍 1901-B Airline Highway, Metairie, LA 70001
Program rules and eligibility criteria change. Please confirm current requirements with the Louisiana Department of Health or Louisiana Medicaid before making decisions for your family.
