The Legislature this year passed a $4 million in line items to mandate new ongoing spending for 200 additional slots for this. Waiver programs let states use federal Medicaid dollars to give services to the developmentally disabled or elderly who would not otherwise qualify for the program on the basis of income or assets, as long as the average cost per client does not exceed what the state would spend on paying for them to live in nursing homes.
Several reasons explain the list’s length. First, Louisiana’s previous strategy, before court decisions forced it to shift emphasis to home- and community-based services, was to warehouse the elderly and disabled into nursing homes, so the abrupt transition meant a lot of catching-up (as well as reducing wasteful spending to nursing homes that seems set to continue for some time, dollars which otherwise could have gone to waiver services). Second, in that rush Louisiana overcompensated in terms of people made eligible for NOW and in the level of services provided across all waiver programs, with the rebalancing beginning only after Jindal took office. Third, with the creation of the several programs beginning with NOW in 2003 (each is petitioned to the federal government, which then must approve them and any changes made after), it was difficult to stitch them together in a way that provided an efficient continuity of care.