What is the Community Choices Waiver?
The Community Choices Waiver (CCW) is a Louisiana Medicaid home and community-based services (HCBS) waiver operated by the Office of Aging and Adult Services (OAAS) under the Louisiana Department of Health. It is designed to help people who would otherwise need a nursing home stay safely in their own home instead. Covered services include support coordination, personal assistance services (PAS), monitored in-home caregiving, adult day health care, home-delivered meals, nursing and therapy assessments, home modifications, assistive technology, and caregiver respite.
The part that lets a family member get paid is the self-direction option. Instead of an agency assigning an aide to you, self-direction makes the Medicaid member (the "beneficiary") the employer of record. As the employer, the beneficiary, or a responsible representative acting for them, recruits, hires, trains, supervises, and can dismiss the person who provides their personal assistance services. That means an adult child, grandchild, sibling, niece, nephew, in-law, or trusted friend who has been helping for years can finally be paid for that work.
Self-direction is voluntary. To use it, the beneficiary must be certified for CCW, complete an overview with a support coordinator, understand the rights and responsibilities of being an employer, and manage an individual budget. A required part of the option is a Fiscal/Employer Agent (F/EA) who provides financial management services, meaning they process payroll, withhold and file taxes, carry workers' compensation and unemployment insurance, and keep the arrangement compliant with labor law. In Louisiana those F/EA vendors are Acumen Fiscal Agent and Morning Sun Financial Services.
Because it is a waiver, CCW does not have unlimited slots. Louisiana keeps a Request for Services Registry (a waitlist), and people are offered a waiver opportunity as slots open, with priority for certain groups such as people with ALS and those leaving a nursing home. Once enrolled, the amount of paid care you receive is set by an assessment of your needs and written into your plan of care.
Community Choices Waiver eligibility requirements
CCW is for the person who needs care, not the caregiver. The beneficiary must meet Louisiana long-term-care Medicaid financial rules and need a nursing-facility level of care. The family member being paid does not need to meet income or asset limits.
Who can - and cannot - be paid through the Community Choices Waiver
Under self-direction, the beneficiary chooses their own worker and can hire most relatives and friends. Louisiana treats a spouse and other "legally responsible" or representative roles differently: a spouse can be paid only under narrow rules. A separate service, Monitored In-Home Caregiving (MIHC), is the path that most clearly allows a spouse to be paid.
- Adult children (18 or older) of the beneficiary
- Grandchildren, siblings, nieces, nephews, aunts, uncles, and in-laws
- Close friends, neighbors, or members of your faith community
- A spouse, but ONLY if OAAS approves the "extraordinary care" criteria (self-directed PAS)
- A spouse as the paid "principal caregiver" under Monitored In-Home Caregiving (MIHC)
- Almost any able adult the beneficiary chooses and trains, no nursing license or CNA needed
- A spouse acting as a routine self-directed PAS worker without approved extraordinary-care status
- The beneficiary's responsible representative (unless that person is the spouse under MIHC)
- Anyone who cannot pass the required criminal background check
- Someone the beneficiary cannot actually supervise (self-direction requires a capable employer or representative)
Community Choices Waiver pay, hours, and overtime
How much a caregiver is paid depends on whether care is delivered as self-directed personal assistance services (paid hourly) or as Monitored In-Home Caregiving (paid to a provider as a daily rate). The number of paid hours is set by the beneficiary's assessed needs and written into the plan of care and individual budget.
Hourly pay
For self-directed personal assistance services in 2026, Louisiana Medicaid reimburses the Fiscal/Employer Agent about $4.63 per 15 minutes (roughly $18.52 per hour) for a single participant. That reimbursement is not all take-home pay: it also has to cover the employer's share of payroll taxes and the F/EA's fee, so the worker's actual wage is set inside the individual budget with help from the support coordinator. Louisiana has required a wage floor for self-directed workers (historically $9 per hour) and requires at least the higher of the wage floor or minimum wage. In practice most family caregivers land somewhere between roughly $9 and $18 per hour depending on the budget. Workers are W-2 employees, so federal taxes are withheld and reported. Monitored In-Home Caregiving instead pays the MIHC provider a daily rate (about $78.63 per day for Level 1 and $117.94 per day for Level 2 in 2026), and the caregiver is compensated through that provider.
Hours and scheduling
There is no single fixed number of hours. The interRAI assessment and your plan of care determine how many personal assistance service hours are authorized, and the individual budget converts that into paid time. Some beneficiaries receive a modest number of hours per week; others with heavy needs receive substantially more. Monitored In-Home Caregiving is a live-in model of continuous support paid per day rather than per hour, so it fits people who need someone in the home around the clock.
Overtime rules
Federal overtime law applies to self-directed workers. A worker who exceeds 40 hours in a workweek for one beneficiary is generally owed overtime, and Louisiana's 2026 fee schedule sets a higher self-directed overtime reimbursement of about $6.26 per 15 minutes (roughly $25.04 per hour). The support coordinator and F/EA help the beneficiary budget so overtime is planned for or avoided, and some families split hours across two workers to stay within the budget.
How to apply for the Community Choices Waiver in Louisiana
- Call Louisiana Options in Long Term Care to get on the Request for Services Registry (the CCW waitlist). This is the required first step, run by OAAS.
- Phone: 1-877-456-1146 (TTY 1-855-296-0226)
- Open Monday through Friday, 8:00 a.m. to 5:00 p.m.; the call is free
- Ask to have your name added to the CCW Request for Services Registry
- Wait to be contacted when a waiver opportunity opens. Because CCW has limited slots, there can be a wait; priority groups (for example people with ALS or those transitioning out of a nursing home) may move faster.
- Complete the Medicaid and level-of-care assessments once you are offered an opportunity.
- Establish long-term-care Medicaid financial eligibility (income and assets)
- Complete the interRAI Home Care (iHC) assessment to confirm nursing-facility level of care
- Have any medical records ready that document the need for daily help
- Choose a support coordination agency. Your support coordinator builds the plan of care, plans the individual budget, and walks you through the self-direction option.
- Elect self-direction and set up your Fiscal/Employer Agent. Complete the self-direction overview, sign employer paperwork, and enroll with the F/EA (Acumen Fiscal Agent or Morning Sun Financial Services), who handles payroll, taxes, and workers' comp.
- Hire and onboard your caregiver.
- Complete a criminal background check for the worker
- Finish employment paperwork (I-9, W-4) through the F/EA
- For a spouse, submit the LRI/Spouse Request Form for OAAS review, or ask about Monitored In-Home Caregiving instead
- Begin submitting time records each pay period so the F/EA can pay the worker
Community Choices Waiver Louisiana frequently asked questions
Can my spouse be paid to care for me through the Community Choices Waiver?
It depends on the path. Under the self-direction option for personal assistance services, a spouse is treated as a "legally responsible individual" and can be the paid worker only if OAAS approves an "extraordinary care" request. That means the interRAI assessment or plan of care must show the beneficiary has extraordinary health needs (things like tube feeding, oxygen, suctioning, dialysis, or hospice) AND that qualified outside workers cannot be found or the spouse has a unique ability to meet the need. You submit an LRI/Spouse Request Form and OAAS decides. The easier route for many couples is Monitored In-Home Caregiving (MIHC), a separate CCW service where a live-in spouse can be the paid "principal caregiver" without meeting that extraordinary-care test. Ask your support coordinator which fits your situation.
How much does the Community Choices Waiver pay a family caregiver in 2026?
For self-directed personal assistance services, Louisiana Medicaid's 2026 fee schedule reimburses about $4.63 per 15 minutes, which is roughly $18.52 per hour, but that amount is not all take-home pay. It also has to cover the employer's share of payroll taxes and the Fiscal/Employer Agent's fee, so the caregiver's actual wage is set inside your individual budget with your support coordinator. Louisiana has enforced a wage floor for self-directed workers (historically $9 per hour) and requires at least the higher of that floor or minimum wage, so most family caregivers earn somewhere between roughly $9 and $18 per hour. Self-directed overtime is reimbursed higher, about $6.26 per 15 minutes. Monitored In-Home Caregiving is different: it pays a daily rate to the provider (about $78.63 per day for Level 1 in 2026), and the caregiver is paid through that provider.
How long does it take to get approved?
Plan for months, not weeks. Because the Community Choices Waiver has a limited number of slots, the first step is getting your name on the Request for Services Registry, and there can be a wait before an opportunity is offered. Priority groups, such as people diagnosed with ALS or those transitioning out of a nursing facility, can move faster. Once you are offered a slot, expect the Medicaid financial determination and the interRAI level-of-care assessment to take up to about three months, sometimes longer. You can keep things moving by having documents ready in advance: proof of Louisiana residency, identification, Social Security information, proof of income and assets, and medical records that support the need for daily help. After approval, setting up support coordination and the Fiscal/Employer Agent adds a few more weeks before the first paycheck.
Does my family caregiver need a license or certification?
No. One of the biggest advantages of self-direction is that the person you hire does not need to be a Certified Nursing Assistant, Home Health Aide, or any licensed professional. As the employer, you (or your responsible representative) train the worker on the specific tasks you need help with, such as bathing, dressing, transfers, meals, and light household tasks. There are still a few requirements handled through the Fiscal/Employer Agent: the worker must pass a criminal background check and complete employment paperwork like the I-9 and W-4. For certain health-related tasks there may be training requirements under Louisiana's direct-service-worker rules. But there is no clinical exam or skills test, which is what makes the program so welcoming to relatives who have already been providing care informally.
Can an adult child or other relative be paid?
Yes. Under self-direction, the beneficiary generally chooses their own worker, and adult children, grandchildren, siblings, nieces, nephews, aunts, uncles, in-laws, and even close friends or neighbors can be hired and paid. The special restrictions in the rules apply to a narrow set of roles, mainly a spouse and other "legally responsible" or representative positions, not to an adult child. So a son or daughter who has been helping a parent can typically be hired directly as the paid personal assistance services worker once the parent is enrolled in CCW and elects self-direction. The worker still has to pass a background check and complete the F/EA onboarding, but no family relationship other than spouse triggers the extraordinary-care approval process.
What is the difference between self-direction and Monitored In-Home Caregiving?
Both let a family member be paid, but they work differently. Self-directed personal assistance services pay by the hour: you become the employer, you hire and supervise the worker, and the Fiscal/Employer Agent runs payroll from your individual budget. It is flexible and good for scheduled help across the week. Monitored In-Home Caregiving (MIHC) is a live-in model of continuous support, paid to an MIHC provider as a daily rate, with professional oversight and electronic daily notes. MIHC is the clearer path for paying a live-in spouse because it does not require the extraordinary-care test that self-direction applies to spouses. One tradeoff: while receiving MIHC you generally cannot also receive certain other CCW services like personal assistance services or home-delivered meals at the same time, so your support coordinator helps you weigh which option fits best.
Who handles payroll, taxes, and paperwork?
A Fiscal/Employer Agent (F/EA) does. Using an F/EA is a required part of the self-direction option, and in Louisiana the vendors are Acumen Fiscal Agent and Morning Sun Financial Services. The F/EA provides financial management services: it processes payroll and pays your worker, withholds and files federal and state employment taxes, carries workers' compensation and unemployment insurance, verifies employment eligibility, tracks time and attendance, and keeps the arrangement compliant with labor law. That means the family member does not have to set up their own payroll system or figure out tax filings. Your support coordinator works alongside the F/EA to plan the individual budget so the hours, wages, and required taxes all fit within what Medicaid authorizes.
Does enrolling in the Community Choices Waiver change my other Medicaid benefits?
No. The Community Choices Waiver adds home and community-based services on top of your regular Louisiana Medicaid coverage; it does not replace your doctor visits, hospital care, prescriptions, or durable medical equipment. CCW is specifically the long-term-care piece that helps you stay at home instead of entering a nursing facility. If you are also on Medicare, Medicare continues to cover acute care such as hospital stays, doctor visits, and short-term skilled home health, while CCW and Medicaid cover the ongoing personal care and supports. The two programs coordinate rather than cancel each other out. Keep in mind you can only be enrolled in one home and community-based waiver at a time, so you cannot stack CCW with another Medicaid waiver simultaneously.
See also: Louisiana caregiver guide
For all the ways to get paid to care for a family member in Louisiana — including Community Choices Waiver, VA programs, long-term care insurance, and more — read the full Louisiana guide.