Aging in Place in Your State: Maine and Louisiana

Maine and Louisiana are pretty far apart in distance (1,563 miles), climate (Maine’s monthly average high temperature never climbs above 80°F, while its monthly low gets as low as 11°F; Louisiana’s average highs can pass 90°F, while its lows rarely go below freezing), and culture (in the north, lobster and ocean and snowy woods; in the south, crawfish and Cajun and piney woods with swamps). But the two states have surprisingly similar offerings to help their senior residents live independently for as long as possible: a fairly standard Medicaid waiver for home and community-based services, and a state program or two that augments that service.Here’s a look at how seniors can get help with home modifications and related services in Maine and Louisiana.MaineSeniors in Maine can access the state’s Elderly and Adults with Disabilities Waiver, a Medicaid HCBS program that serves residents who need the level of care of a nursing home but want to remain in their own residences. Like many similar programs, the Maine waiver has a self-directed option in which beneficiaries have a say in determining their own care. The program is not an entitlement program, which means waiting lists for services may exist, but the terms of the program are relatively generous. In addition to help with meal delivery and various types of personal and health care, the program offers benefits for home modifications that preserve or increase independence. To qualify, applicants must be Maine residents and qualify for services under Medicaid; roughly, this means that a single person must not have income greater than about $1,100 a month, with a $10,000 cap on allowable assets (a primary home valued at up to $893,000, some home contents, and other assets like personal effects and pre-purchased burial plots are not counted). These limits differ for a married couple.In addition to the Medicaid waiver, Maine residents who need home modifications can access a state-based program, the Consumer-Directed Home-Based Care (CDHBC) program, which is administered through the Maine Housing Authority. CDHBC exists to “provide long term care services to assist eligible consumers to avoid or delay inappropriate institutionalization,” according to the state web site. Again, this is not an entitlement program, so “provision of these services is based on the availability of funds.” Those who do qualify for the program work with a case manager on a plan of care that can include vehicle adaptations (“adapted carrier and loading devices, one communication device for emergencies, adapted equipment for driving”), home access modifications (“ramps, tub/shower modifications and accessories, power door openers, shower seat/chair, grab bars, door widening, environmental controls”), and communication devices including “adaptations to computers, speaker telephones, TTY (to help hard-of-hearing people send and receive typed messages over phone lines), and personal emergency response systems.”For homeowners, the housing authority also offers the Home Accessibility and Repair Program, which “provides help to low-income homeowners who cannot afford necessary home repairs in the form of a grant.” Homeowners can use the grant for issues like well repair and replacement, heating and electrical system repairs, structural repairs, lead paint mitigation, and energy-efficient upgrades, as well as “improvements necessary to permit use by persons with disabilities or who are experiencing physical barriers living at the home.”To qualify, applicants must own and have lived in the home needing repairs for at least one year and have a household income at or below 80 percent of area median income, which ranges anywhere from $37,700 a year for a single person living in Aroostook, Piscataquis, and several other areas to $103,650 for a household of eight people living in the Portland and York areas.For more information about Maine’s Medicaid waiver and the CDHBC and home repair programs, visit the Maine Department of Health and Human Services at https://www.maine.gov/dhhs/ and the Maine Housing Authority at https://www.mainehousing.org/.LouisianaLouisiana’s Medicaid waiver program, the Community Choices Waiver, is also not an entitlement program; priority is given on waiting lists to applicants deemed to have the greatest need. But residents who are able to qualify and receive benefits can access such services as case management, transition support for moving out of nursing homes, the installation of assistive devices and technologies, and “home modifications to aid in self-care,” according to the state Department of Health’s Aging and Adult Services division. Related services like housing transition services and housing stabilization services are also covered.To qualify, Louisiana residents must be at least 21 years old, require a nursing home level of care, and meet Medicaid eligibility standards for income and assets. Currently, this is about $2,350 per month for single applicants, as well as “liquid” assets not in excess of $2,000, with a primary home valued at up to $595,000, a personal vehicle, and certain personal possessions. These limits change if the applicant is married, including scenarios in which just one spouse is applying and where both spouses intend to apply for benefits.In addition, Louisiana runs the Permanent Supportive Housing (PSH) program, which provides a suite of services designed to help people find and stay in safe, subsidized rental housing. The program offers “flexible, individualized housing supports to people with disabilities,” including tenancy support services like document procurement and completion, tutoring in daily living skills and self care, assistance communicating with landlords and neighbors, social support, individual counseling, and crisis intervention.To qualify, residents must have an income at or below 50% of area median income; the statewide average is $26,295 median income for a single person and $49,469 for a household. They also must have a “substantial, long-term disability,” including developmental disabilities, serious mental illness, disabilities acquired after the age of 22, and age-related disabilities, including being “frail” and “elderly.”For more information about these programs, visit the Louisiana Department of Health’s Aging and Adult Services division at https://ldh.la.gov/index.cfm/subhome/12.