Medicaid long-term care benefits can cover the cost of a nursing home, an assisted living alternative, or in-home care once you meet Louisiana's income, asset, and medical requirements. Coverage falls under three main pathways: Institutional Medicaid for nursing facilities, Home and Community Based Services (HCBS) waivers for care at home, and the Program of All-Inclusive Care for the Elderly (PACE). The Louisiana Department of Health decides who qualifies for each, using rules that change every year and look back five years into your finances.
Getting approved comes down to four steps: check your eligibility, gather your financial records, file the application, and handle any income above the limit through the state's spend-down program. Nursing home coverage is available to anyone who meets the requirements, while HCBS waiver slots are limited and can involve a waiting list, so the timeline can vary depending on which pathway fits your situation. Oak Grove Estate Planning's elder law attorneys, led by founder Andrew Mims, have guided Louisiana families through this process for nearly 15 years.
Here's what to expect at each step.
- Confirm your income, assets, and level-of-care eligibility
- Gather five years of financial records for the look-back review
- File your application with the Louisiana Department of Health
- Handle income above the limit through the Medically Needy spend-down program
Step 1: Confirm You Meet Louisiana's Medicaid Long-Term Care Eligibility Rules
Louisiana sets firm income and asset limits for Medicaid long-term care, and you need to fall under both to qualify. In 2026, a single applicant's countable income cannot exceed $2,982 per month, and countable assets cannot exceed $2,000. Home equity above $752,000 can disqualify you unless a spouse, minor child, or disabled child still lives in the home. A car, household goods, and a prepaid burial plan are generally excluded from the asset count.
Meeting these limits is one part of qualifying. Louisiana also requires proof that you need a Nursing Facility Level of Care, a functional assessment that measures how much help you need with daily activities like bathing, dressing, and mobility. The Office of Aging and Adult Services typically conducts this assessment for elderly and physically disabled applicants, while the Office for Citizens with Developmental Disabilities handles it for applicants with developmental disabilities. Oak Grove Estate Planning keeps an updated breakdown of current income limits, asset exemptions, and level-of-care standards on its Louisiana Medicaid planning page.
Income and Asset Rules for Married Couples
Married couples follow a different set of rules, since one spouse may need care while the other continues to live at home. Only the applying spouse's income counts toward the $2,982 limit, and the at-home spouse's income is not affected by the application.
Louisiana also protects the at-home spouse's assets and income under its spousal impoverishment provisions, found in the Medicaid Eligibility Manual, Section I-1660. Based on the federal spousal standards Louisiana applies each year, the at-home spouse can generally keep up to $162,660 in protected assets and up to $4,066.50 per month in income before the applying spouse's income and assets are counted against them. These figures adjust annually, so it's worth confirming the current amounts before filing.
Step 2: Gather Financial Documentation for the 5-Year Look-Back Review
Louisiana reviews five years, or 60 months, of your finances before approving long-term care benefits. The Louisiana Department of Health checks this period for any transfers of money or property that could have been made just to qualify.
Before you apply, gather:
- Bank, investment, and retirement account statements for the past 60 months
- Property deeds and records of any real estate transfers
- Records of gifts, loans, or transfers to family members
- Life insurance policies and burial or funeral contracts
- Proof of income, such as Social Security award letters and pension statements
Start collecting these early. Banks and title companies can take weeks to produce older statements, and gaps in the record make it harder to explain a transaction that Medicaid flags during review.
If Medicaid finds a transfer made for less than fair value during the look-back period, it can impose a penalty period, a stretch of time during which Medicaid won't pay for care even if you're otherwise eligible. This applies to more than outright gifts. Selling a home to a family member below market value, adding someone to a bank account, or forgiving a loan can all count as a transfer that Medicaid reviews. The length of any resulting penalty depends on the value transferred, so any transaction from the past five years should be documented and ready to explain.
A family member can apply on the applicant's behalf with the right documentation, such as a power of attorney. LDH allows this specifically so that adult children or other caregivers can manage the process for a parent who can't handle it themselves. Whoever files the application, keeping a complete copy of everything submitted, along with proof of when and how it was sent, makes it easier to resolve any question LDH raises later.
Step 3: File Your Application With the Louisiana Department of Health (LDH)
The Louisiana Department of Health (LDH) is the state agency that determines Medicaid eligibility in Louisiana, including for long-term care. A dedicated long-term care unit within LDH reviews every application against the income, asset, and level-of-care rules covered in Step 1, then continues to manage the case once benefits are approved. According to LDH's guide to applying for Medicaid, you can apply through several channels:
- Online through the Medicaid Self-Service Portal, the fastest option for most applicants
- By mail or fax with a printed application from LDH
- By phone at 1-888-342-6207
- In person at a local Medicaid office
Each method routes to the same review team, so choose whichever is easiest for you or your family. Alongside the five-year financial records from Step 2, LDH's long-term care application also asks for basic identifying information: a photo ID, Social Security number, proof of citizenship or immigration status, and any Medicare card if the applicant has one. Having these ready before you start the application helps avoid a back-and-forth with LDH later.
What Happens After You Apply: Timelines and Common Delays
LDH generally completes a decision within 90 days of receiving a complete application, though the process can take longer if it needs more information. Expect at least one follow-up request for documents during that window.
Most delays come from incomplete look-back records, unexplained transfers, or a missing Nursing Facility Level of Care determination. Responding quickly to any LDH request keeps a case moving toward a decision.
What to Do If Your Application Is Denied
You have the right to appeal an LDH denial. According to LDH's Medicaid FAQ, you can request an appeal by phone through Medicaid Customer Service at 1-888-342-6207 or by contacting the Division of Administrative Law directly at 225-342-5800.
Filing an appeal quickly matters, since appeal requests are subject to deadlines. A written appeal can go by fax to 225-219-9823 or by mail to the Division of Administrative Law, Department of Health Section, P.O. Box 4189, Baton Rouge, LA 70821-4189.
Step 4: Address Excess Income Through Louisiana's Medically Needy Spend-Down Program
Louisiana allows a spend-down option through the Long Term Care Medically Needy Program. If your income exceeds the state limit, you can qualify by putting excess income toward your medical and care costs each month.
Your excess income counts against incurred medical expenses, including nursing facility charges, until what's left falls under the limit. LDH recalculates this spend-down amount every month, so eligibility can shift if income or care costs change. For example, if your monthly income is $3,200, and your nursing facility charges exceed the $218 difference, that excess income is applied toward the bill and you remain eligible for that month.
A similar spend-down option exists for HCBS waiver applicants whose income exceeds the limit, under Section H-1050 of the same manual, so the option isn't limited to nursing facility care.
The spend-down math involves income, allowable deductions, and monthly medical bills all at once, so a small error can delay a case. Oak Grove Estate Planning typically reviews a client's full financial picture before submitting figures to LDH.
Get Guidance From a Louisiana Elder Law Attorney Before You Apply
Applying for Medicaid long-term care in Louisiana involves federal rules, state-specific limits, and a five-year financial review that leaves little room for error. Andrew Mims and his team have walked Louisiana families through every stage of this process, from the first eligibility check through the final LDH decision. Many families find that the financial rules shift once a spouse, a home, or a past gift enters the picture, which is where an early conversation with an attorney tends to save the most time.
Oak Grove Estate Planning's support doesn't end once an application is filed. The firm offers ongoing check-ins and unlimited advice to its clients, so a plan built today can be updated as income, care needs, or family circumstances change down the road.
If you want a second set of eyes on your application, or you're unsure how a spend-down or a past transfer will affect your eligibility, schedule a complimentary consultation with Oak Grove Estate Planning's Lafayette office before you file. Call (337) 279-2641 or book an appointment online.
The information on this page is provided for general educational purposes only and does not constitute legal advice. Every case is different. Past results do not guarantee future outcomes.
Sources
- Louisiana Department of Health, Medicaid Eligibility Manual, Section I-1700: ldh.la.gov/assets/medicaid/MedicaidEligibilityPolicy/I-1700.pdf
- Louisiana Department of Health, Medicaid Eligibility Manual, Section I-1660: ldh.la.gov/assets/medicaid/MedicaidEligibilityPolicy/I-1660.pdf
- Louisiana Department of Health, Long-Term Care FAQs: ldh.la.gov/faq/category/24
- Louisiana Department of Health, How to Apply Online for Louisiana Medicaid: ldh.la.gov/assets/Medicaid/HealthyLa/LaMeds/SSP_How_to_Apply_Guide.pdf
- Louisiana Department of Health, Application for Long-Term Care Services: ldh.la.gov/assets/medicaid/medicaideligibilityforms/longtermcare.pdf
- Louisiana Department of Health, Medicaid Eligibility Manual, Section H-1040: ldh.la.gov/assets/medicaid/MedicaidEligibilityPolicy/H-1040.pdf
- Louisiana Department of Health, Medicaid Eligibility Manual, Section H-1050: ldh.la.gov/assets/medicaid/MedicaidEligibilityPolicy/H-1050.pdf
