Supports Waiver - Louisiana Department of Health and ... 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section I: Employer Information. Fill in your LA Revenue Account Number or SSN, FEIN, Date of Application, Legal Name, Trade Name, and Address details including City, State, and ZIP.
  3. Proceed to Section II: Employee Information. Enter the employee’s name, SSN, and address details as required.
  4. In Section III: Employer Declaration, confirm the accuracy of your application by signing and dating the form.
  5. After submission, wait for Section IV to be completed by the Department of Health. Once received back, complete Sections V and VI regarding employment details and deductions.

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Effective 3/1/2025* ProgramFamily Size/Monthly Income Limits 12 LaCHIP - for children $2,831 $3,825 LaCHIP Affordable Plan - for children $3,326 $4,495 LaMOMS - for pregnant women $2,4336 more rows
The NOW is intended to provide specific, activity-focused services rather than continuous custodial care. To qualify for the New Opportunities Waiver, a person must: Meet Medicaid Eligibility AND. Be 3 years of age or older AND.
The Medicaid waiver programs eligibility rules vary, but a person must meet their states level of care requirement. This means an individual qualifies for full-time inpatient care at an appropriate facility but remains at home.
In order for individuals to qualify for the CCW program, they must: Meet long-term care (LTC) Medicaid eligibility; AND. Be 21 years old or older; AND. Meet nursing home level of care.
How to Apply. Individuals who have a need for services should contact their local Human Services District/Authority in order to go through the eligibility determination process. Once a person is eligible for OCDD services, they may ask to be added to the Developmental Disability Request for Services Registry(RFSR).

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The New Opportunities Waiver (NOW) program provides services in the home and in the community to individuals 3 years of age or older who are eligible to receive OCDD waiver services. The NOW is intended to provide specific activity-focused services rather than continuous custodial care.

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