LOUISIANA LEGAL SERVICES AND PRO BONO DESK MANUAL 2013

MEDICAID
waiver. 494 The waiver is for full Medicaid coverage with additional behavioral
health services. 495 Adults not otherwise eligible for full Medicaid qualify only if
they meet the very low Medically Needy Income Levels.
At the time of publication, the LBHP is fairly new and experience under it is
still developing.
8.7.7. “Personal care services” to assist with transferring, bathing, feeding,
and similar care in the home:
“Personal care services” are to help with activities such as transferring,
bathing, feeding, medication reminders, food preparation, and some housekeeping
in the home that the recipient is unable to perform for him or herself. But there
are eligibility criteria for the services, based on certain specific needs of the recipient.
While a personal care services worker can do all of these activities if
approved to be on site, a recipient does not qualify just because at least one of
the forms of assistance is needed.
Under federal guidance, the services can involve “cueing” to remind persons
with cognitive impairments of activities they need to perform. 496 But these aspects
are not central to the service, and so presumably need not be covered by the state,
unless necessary for an EPSDT recipient (under the age of 21). 497 Louisiana’s
regulations do not recognize cueing as part of the service.
Louisiana conceives personal care services as dealing with the physical
aspects of these activities, and requires that the recipient or their representative
be able to direct the personal care worker. For recipients under age 14 and older
children not able to direct their care, Louisiana Medicaid requires that another
caretaker (usually a parent) be on-site at all times to direct the worker. 498
Louisiana’s personal care services offerings differ based on a recipient’s age.
For recipients under age 21 service is through “EPSDT-PCS.” For recipients over
age 21 service is through “LT-PCS.” LT stands for “Long Term.” The two offerings
are very different, both as to eligibility standards and services.
State policy used to put a 4 hour a day limit on the services for EPSDT recipients.
States cannot place numerical limits on services for EPSDT recipients. The
limit has been rescinded, but few recipients receive over 4 hours a day.
One seeks EPSDT-PCS by finding a provider, which submits paperwork to
the state, including a form from the recipient’s physician, seeking prior approval
of the service. 499
The LT-PCS for non-EPSDT recipients currently allows up to 32 hours a week
of the service. 500 The Department has repeatedly been reducing the maximum
over time, as a budget-saving measure. Reductions may have Americans with Dis-
494
MEM §§ H-2720, H-900.
495
MEM §H-2720.
406
CMS State Medicaid Manual § 4480(C), .
497
See Rodriguez v. City of New York, 197 F.3d 611 (2d Cir.), cert. denied 531 U.S. 864 (1999). Rodriguez preceded the CMS
“cueing” guidance. But in Rodriguez the Court left it to the state to define the purpose of a service, so the federal guidance
might not affect the outcome. The author believes that the purpose of a service is a matter of federal law, not
state discretion. See Ledet v. Fischer, 638 F.Supp. 1288, 1291 (M.D.La. 1986).
498
LAC. title 50, part XV, § 7305(A)(4).
499
Providers can be found through http://www.lamedicaid.com/provweb1/provider_demographics/provider_map.aspx
500
38 La.Reg. 329 (February 2012), § 12915(A).
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