I get the same call a lot, usually from a daughter or a son. Mom is managing, mostly. But she’s had a fall, or bathing alone has started to scare everyone in the family, including her. LT-PCS is already in place, or it’s the first thing we talk about — and then someone asks the real question: what happens when 32 hours a week isn’t enough?
That’s the moment I bring up the Community Choices Waiver. In Louisiana, the Community Choices Waiver is a Medicaid home and community-based services program built for older adults and adults with disabilities who need nursing-home-level care but want to stay in their own home. I’ve watched this program keep people in Metairie, Jefferson Parish, and across the greater New Orleans area out of a nursing facility they never wanted to enter. I’ve also watched families get confused by how it works, especially the waiting list, because nobody explained it plainly. So let’s do that here.
What Is the Community Choices Waiver?
The Community Choices Waiver, often shortened to CCW, is administered by the Louisiana Department of Health’s Office of Aging and Adult Services. According to LDH, it’s a home and community-based service for older adults and people with adult-onset disabilities who would otherwise need to be cared for in a nursing facility.
The word “waiver” matters here. A Medicaid waiver lets the state use Medicaid funds to pay for services at home instead of in an institution — but because funding is limited, waivers work differently than a Medicaid State Plan service like LT-PCS. There’s a set number of openings, and most people go on a request list first. I’ll walk through how that works below, because it’s the part that trips families up most.
One thing LDH is direct about, and I want to be just as direct with you: CCW does not provide help 24 hours a day, either on its own or combined with other Office of Aging and Adult Services programs. It’s a substantial, well-rounded program — but not round-the-clock care. Knowing that up front saves families a hard surprise later.
Who Qualifies for the Community Choices Waiver in Louisiana?
The eligibility test has three parts. A person must meet all three, per LDH:
- Meet long-term care Medicaid eligibility, and
- Be 21 years of age or older, and
- Meet nursing home level of care
That first requirement — long-term care Medicaid eligibility — has its own income and asset rules, and those figures are reviewed and adjusted by the state. I’m not going to quote numbers here, because a figure that’s out of date can send a family down the wrong path with confidence they shouldn’t have. Please confirm current income and resource limits directly with Louisiana Medicaid or Louisiana Options in Long-Term Care before you plan around them.
“Nursing home level of care” is a clinical determination, not a general sense that someone needs help. It’s assessed formally during the application process, covered below.
What if my loved one is already on Medicaid?
If Medicaid is already in place, and your loved one is 21 or older, the next real question isn’t “do we qualify” — it’s “how long is the wait, and where does our family fall in line.” That’s where priority groups come in.
How the CCW Waiting List Actually Works
This is the part I explain slowest, because it’s the part that determines everything about timing.
LDH keeps what’s called a Community Choices Waiver Request for Services Registry — essentially a waiting list, organized by the date someone requested services. Most people are offered a spot first-come, first-served, based on that date. But certain situations move ahead of the general line. According to LDH, priority is given to:
- People who have been abused or neglected and are referred by Adult or Elderly Protective Services, who would need nursing home placement without CCW services
- People diagnosed with amyotrophic lateral sclerosis (ALS)
- People residing in, or linked to, a State of Louisiana Permanent Supportive Housing unit
- People currently living in a nursing home where Medicaid is the only payer
- People who are not currently receiving services through PACE, LT-PCS, or another Medicaid home and community-based waiver
Everyone else receives an offer for services on a first-come, first-served basis, by the date of their request.
The path from LT-PCS to an expedited CCW offer
Here’s a detail I bring up with almost every family already on LT-PCS: if your loved one is approved for the full 32 hours of LT-PCS per week and would require nursing home placement without more support, that can qualify them for an expedited Community Choices Waiver opportunity — ahead of the general waiting list. I wrote about this in more detail in our LT-PCS guide, but it’s worth repeating here: reaching the LT-PCS cap isn’t a dead end. For a lot of the families I sit with, it turns out to be the very thing that moves them toward CCW faster than they expected.
This is why I tell families to ask about a registry the moment it becomes relevant, not after the need becomes urgent. The date of your request is what the state uses to measure your place in line — not the date your situation became difficult.
What Services Does CCW Cover?
This is where the Community Choices Waiver earns its reputation as one of the more comprehensive home and community-based programs in Louisiana. Per LDH, CCW can include:
- Support coordination — a coordinator (case manager) who helps arrange and monitor your services
- Personal assistance services — help with bathing, dressing, meal preparation, and other self-care tasks
- Nursing services — in-home nursing care when it’s needed
- Skilled maintenance therapy — physical, occupational, and speech therapy
- Adult Day Health Care — medical and social services provided at a community-based center
- Home-delivered meals — up to two meals a day
- Environmental accessibility adaptations — ramps, widened doorways, grab bars, roll-in showers
- Assistive devices, medical supplies, and assistive technology
- Personal Emergency Response System — a wearable device that calls for help at the push of a button
- Caregiver Temporary Support — respite care, giving family caregivers a real, structured break
- Monitored In-Home Caregiving — a principal caregiver who lives with the participant and helps with daily self-care
- Financial Management Services — support with hiring and paying workers if a family chooses self-direction
- Transition services — for people moving out of a nursing home back into the community
That last one matters more than people expect. If your loved one is in a nursing facility and wants to come home, CCW includes Transition Intensive Support Coordination and Transition Services designed to help make that move.
CCW vs. LT-PCS: Which One Is Right for Your Family?
I get this question constantly, so let me lay it out plainly.
LT-PCS is a Medicaid State Plan service. There’s no waiting list — if a person meets the criteria, services begin. But it’s capped at 32 hours a week and covers a narrower set of services, mostly personal care and light household help.
CCW is a waiver. It offers a much wider range of services — home modifications, respite, nursing, therapy, home-delivered meals — but it usually involves a request list, unless a priority category applies.
For many families, the right answer isn’t “one or the other.” It’s LT-PCS first, while a CCW request is on file, with a possible expedited move to CCW if the need grows. I covered this landscape, along with private pay and EPSDT for children, in our guide on how to pay for in-home care in Louisiana.
How to Apply for the Community Choices Waiver in Jefferson Parish and Greater New Orleans
The process starts the same way regardless of where you live in Louisiana:
- Confirm Medicaid eligibility. If your loved one isn’t yet on Medicaid, that has to be established first. Our step-by-step guide to applying for Medicaid waiver services in Louisiana walks through that process.
- Call Louisiana Options in Long-Term Care at 1-877-456-1146 (TTY 7-1-1) to request Community Choices Waiver services and be added to the registry. This step matters even if you’re not sure the timing is right — the request date is what protects your place in line.
- Complete a level-of-care assessment, confirming your loved one meets nursing home level of care.
- Receive a plan of care, developed with a support coordinator, outlining which services are approved.
- Choose a Medicaid-enrolled provider through freedom of choice, and services begin.
If you’re not sure your loved one is ready for this conversation, our guide on how to know if your loved one needs in-home care can help you think it through before you make the call.
How AAA Care Helps
For more than twenty-two years, AAA Care, LLC has worked alongside families across Metairie, Kenner, New Orleans, and the surrounding parishes as a Medicaid-enrolled provider. We help families understand where they stand with LT-PCS and the Community Choices Waiver, help get requests on file at the right time, and once services are approved, we’re the hands doing the daily work — personal care, mobility support, meal preparation, and the steady presence that lets someone stay home.
Dignity and independence aren’t about doing everything alone. They’re about having the right support in place, and someone beside you who knows this system and won’t let your family fall through the cracks of it.
Frequently Asked Questions
What is the Community Choices Waiver in Louisiana?
The Community Choices Waiver (CCW) is a Louisiana Medicaid home and community-based services program for older adults and adults with adult-onset disabilities who meet nursing home level of care. It allows eligible participants to receive services like personal care, nursing, home modifications, and caregiver respite at home instead of in a nursing facility.
Who qualifies for the Community Choices Waiver?
To qualify, a person must meet long-term care Medicaid eligibility, be 21 years of age or older, and meet nursing home level of care, according to the Louisiana Department of Health. Income and resource limits apply and should be confirmed directly with Louisiana Medicaid.
Is there a waiting list for the Community Choices Waiver?
Yes, in most cases. LDH maintains a Request for Services Registry, and most people are offered services first-come, first-served based on their request date. Certain groups, including people referred by protective services, people with ALS, and people already approved for the maximum 32 hours of LT-PCS who would otherwise need nursing home placement, may receive an expedited offer.
What is the difference between LT-PCS and the Community Choices Waiver?
LT-PCS is a Medicaid State Plan service with no waiting list, capped at 32 hours of care per week. The Community Choices Waiver is a broader Medicaid waiver program that can include home modifications, nursing, therapy, respite, and home-delivered meals, but generally involves a request list unless a priority category applies.
Does the Community Choices Waiver provide 24-hour care?
No. LDH is explicit that CCW does not provide support 24 hours a day, either alone or combined with other Office of Aging and Adult Services programs. It’s designed to supplement care, not replace round-the-clock supervision.
How do I apply for the Community Choices Waiver in Louisiana?
Confirm your loved one has Louisiana Medicaid, then call Louisiana Options in Long-Term Care at 1-877-456-1146 (TTY 7-1-1) to request services and be added to the registry. You can also call AAA Care at (504) 482-1700, and we’ll help you figure out the right next step.
Ready to Talk It Through?
If you’re trying to figure out whether your loved one qualifies for the Community Choices Waiver, or you’re already on the registry and wondering what comes next, we’re here for that conversation. There’s no charge to call, and you’ll come away 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, income limits, and resource limits with the Louisiana Department of Health or Louisiana Medicaid before making decisions for your family.
