Louisiana home care programs

Home health: the medical benefit

In Louisiana, skilled home health is Home health services (Louisiana Medicaid) (HHA). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Louisiana Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Louisiana the agency route is Long-Term Personal Care Services (LT-PCS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. Long-Term Personal Care Services (LT-PCS) lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Louisiana's consumer-directed option is Self-Direction. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Self-Direction allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Louisiana offers structured family caregiving through Monitored In-Home Caregiving (MIHC). A family member who lives with the person provides day-to-day care and is paid a daily stipend rather than hourly wages.

An agency that holds the Medicaid contract enrolls the household, coaches the caregiver, checks in on a set schedule and keeps the care notes. Unlike consumer-directed care, the caregiver does not become anyone's employee by the hour, and the agency, not the family, is the Medicaid provider.

Other ways Louisiana pays for care at home

Waiver in-home services: Adult Day Health Care Waiver (ADHC), Community Choices Waiver (CCW), and OCDD tiered developmental disability waivers (NOW). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home health services (Louisiana Medicaid) (HHA)).
• Needs daily help and wants an agency to supply and manage the aide: Long-Term Personal Care Services (LT-PCS).
• Wants to choose the aide, including a relative where allowed: Self-Direction.
• Lives with a family member who provides care most of the day: Monitored In-Home Caregiving (MIHC).
• Meets nursing-home level of care and needs more than personal care: Adult Day Health Care Waiver (ADHC), Community Choices Waiver (CCW), and OCDD tiered developmental disability waivers (NOW).