How Louisiana pays for disability services

Waiver inventory

Total across the four OCDD waivers: 14,887 people as of June 30, 2025. Louisiana operates a Tiered Waiver system: children enter through Children's Choice, then ROW, then NOW. Source: laddc.org and medicaid.gov

Louisiana has no 1915(i), 1915(k)/Community First Choice, or 1115 authority serving the IDD population. Its other 1915(c) waivers (Adult Day Health Care 0121, Community Choices 0866, Coordinated System of Care 0889) serve aging, physical disability, or serious emotional disturbance populations and are excluded.

State-only funded programs

• Flexible Family Funds. Monthly stipends to families of eligible children from birth to age 18 with severe or profound developmental disabilities, to offset extraordinary costs of care at home. Administered by OCDD through the ten Local Governing Entities (human services districts and authorities). Awards are first-come, first-served. The per-family stipend amount is not published on any LDH page I could retrieve. ldh.la.gov
• Individual and Family Support (IFS) Services. State-funded respite, personal assistance, specialized equipment, and crisis intervention delivered through the Local Governing Entities for people not receiving waiver services. Administering agency: OCDD via LGEs. ldh.la.gov
• State-operated ICF/IID and OCDD administration. OCDD's own FY2025 appropriation is $219,895,660 total means of financing, of which $43,250,725 is State General Fund, $164,267,003 interagency transfers, $4,142,385 fees and self-generated, $419,000 statutory dedications, and $7,816,547 federal. house.louisiana.gov

I could not find a published dollar appropriation broken out for Flexible Family Funds or IFS specifically. I checked the LDH FY2025 House Appropriations budget presentation, the OCDD services and programs page, the OCDD Q2 2025 quarterly report, and the Louisiana Division of Administration budget documents.

County / regional / local funding

None identified. Louisiana delivers developmental disabilities services through ten Local Governing Entities (human services districts and authorities such as Acadiana Area HSD, Central Louisiana HSD, Metropolitan HSD). These are state-created regional bodies funded through state general fund and interagency transfers from LDH under contract, not through parish levies, millages, or parish general revenue. I checked the LDH services directory, the Central Louisiana HSD 2025-2030 strategic plan, and the Louisiana Division of Administration schedule 09-304 for Metropolitan HSD, and found no local tax stream dedicated to developmental disabilities. ldh.la.gov and doa.la.gov

Funding scale

• SFY2025 total annual waiver services payments across NOW, ROW, Children's Choice, and Supports Waiver: $691.7 million (as of July 2, 2025). laddc.org
• Average annual cost per waiver recipient SFY2025: $49,327. Same source.
• OCDD agency appropriation FY2025 (separate from Medicaid waiver payments, which sit in Medical Vendor Payments): $219,895,660 total, $43,250,725 State General Fund. house.louisiana.gov
• FMAP: 68.06% FY2025, 67.83% FY2026, 68.14% FY2027. Applying the FY2025 FMAP to $691.7 million implies roughly $470.8 million federal and $220.9 million state, though I did not find a published Louisiana state/federal split for waiver spending. kff.org
• People served in DD waivers: 14,887 (6/30/2025). Same OCDD quarterly report.
• Waiting list: 13,841 people on the Request for Services Registry as of June 30, 2025. Louisiana uses SUN (Screening for Urgency of Need) scores 0 to 4; OCDD states that "waiver offers are made to all individuals with a SUN score of 3 or 4, so no individual with current unmet needs is on the DD Request for Services Registry." OCDD conducted 957 screenings April through June 2025. Average wait time is not published. laddc.org
• ICF/IID: state-operated census of 432 at Pinecrest and 90 at Central Louisiana Supports and Services Center as of the Q2 2025 report.

Residential funding detail

Louisiana funds a wide residential continuum, but it is split across waivers and priced very differently.

NOW (the largest waiver, 6,960 people): - Supported Independent Living (SIL), procedure code T2016, paid as a flat $20.00 per day to a residential habilitation provider. This is a supervisory and oversight payment; the actual direct support hours come separately through Individual and Family Support (IFS). - Individual and Family Support, S5125, day and night, $4.63 per 15 minutes ($18.52 per hour) at 1:1, with shared rates of $3.20 (2 people) and $2.71 (3 people). - Substitute Family Care (adult foster care), S5140, $20.00 per day. - Complex Care Supplemental Payment, S5126, $38.88 per diem for people with high medical or behavioral acuity.

ROW (2,167 people) is Louisiana's acuity-tiered residential waiver. ICAP (Inventory for Client and Agency Planning) acuity scores set four levels (intermittent, limited, extensive, pervasive), and residential rates step with the tier: - Host Home, S5140, adults 18 and over: $52.67, $57.05, $64.11, $69.32 per diem across the four acuity tiers. Children under 18: $52.95, $57.05, $64.11, $68.95 per diem. - Companion Care, S5136: $92.02 per diem. - Shared Living, T2016, new (non-conversion) option up to 3 people, provider-leased or participant-leased residence: $82.33, $90.81, $104.08, $123.09 per diem across tiers. A separate Shared Living Conversion option covers up to 4 people (and larger conversion homes) at separate rates in the same fee schedule. - Community Living Supports, S5125: $4.63 per 15 minutes at 1:1, $3.31 (2 people), $2.71 (3 people). - Monitored In-Home Caregiving, T2033: $90.03 per diem Level 1, $135.04 per diem Level 2, plus a one-time $250 assessment (T1028 TU).

Children's Choice funds only in-home Family Support ($4.38 per 15 minutes) and Crisis Support inside a $20,650 annual all-services budget. Supports Waiver funds no residential service at all.

Room and board is not state-funded and falls to the individual. The ROW manual states payment "does not include room and board, maintenance, upkeep, and/or improvement of the beneficiary's or family's residence" (multiple service sections). The NOW manual states "the cost of room and board is not included in the reimbursement paid to the CBR provider" and that Substitute Family Care "does not include payment for room and board." Room and board is met from the person's own income, principally SSI. lamedicaid.com and lamedicaid.com

ICF/IID per diems are facility-specific prospective rates set by rule, not published as a fee schedule on the lamedicaid.com fee schedule index. I checked the OCDD, OAAS, and Other fee schedule indexes and found no ICF/IID rate table.

Comparable service rates

All rates below are from the OCDD fee schedules issued March 13, 2026 (replacing December 9, 2025).

Official rate schedule links

• OCDD fee schedule index with full version history: lamedicaid.com
• New Opportunities Waiver, current (03/13/2026): lamedicaid.com
• Residential Options Waiver, current (03/13/2026): lamedicaid.com
• Children's Choice Waiver, current (03/13/2026): lamedicaid.com
• Supports Waiver, current (03/13/2026): lamedicaid.com
• Prior NOW schedules for change tracking: lamedicaid.com lamedicaid.com lamedicaid.com
• NOW provider manual (Chapter 32, Medicaid Services Manual): lamedicaid.com
• ROW provider manual: lamedicaid.com
• Children's Choice provider manual (Chapter 14): lamedicaid.com

Notable features and flags

• March 13, 2026: OCDD reissued all four waiver fee schedules, replacing the December 9, 2025 versions. Comparing the current NOW schedule against the December 10, 2024 version, the core Individual and Family Support rate held at $4.63 per 15 minutes, so the 2025 and 2026 reissues appear to be code and structure changes rather than an across-the-board rate increase. Supports Waiver was reissued twice in quick succession (February 4, 2026 then March 13, 2026).
• June 30, 2025: The Request for Services Registry stood at 13,841 people, but OCDD reports that every person scoring SUN 3 or 4 (urgent or emergent unmet need) receives a waiver offer, so the registry functions as a planning list rather than a conventional waiting list. Of 957 screenings in Q2 2025, 19% scored 4 and 19% scored 3.
• SFY2025: Waiver payments reached $691.7 million serving 14,887 people, an average of $49,327 per person, well below national averages for comprehensive DD waivers, reflecting Louisiana's heavy use of low-cost tiers (Children's Choice at a $20,650 annual cap and the Supports Waiver with no residential service).
• Tiered Waiver design: All children enter through Children's Choice and move up through ROW to NOW as needs escalate. This is unusual nationally and means the "waiver" a person holds is a poor proxy for their support level. ROW alone uses ICAP acuity tiers to price residential services. ldh.la.gov
• Self-direction: Available across the OCDD waivers, with a Financial Management Services monthly administrative fee of $105.88 (W7319) on the Children's Choice schedule.
• Institutional census persists: Pinecrest Supports and Services Center held 432 residents with 24 admissions against 10 discharges in 2025 year to date, meaning the state-operated ICF/IID population grew during the reporting period.

Confidence

Solid: waiver enrollment, registry size, SFY2025 waiver spending and per-person cost (all from the OCDD Q2 2025 quarterly report), every rate in the comparable services table (pulled directly from the March 13, 2026 fee schedule PDFs), room and board exclusion (verbatim from the NOW and ROW provider manuals), CMS control numbers, and FMAP. Estimated: the state/federal split of the $691.7 million, which I derived from FMAP rather than a published figure, and which I have flagged as such. Not found: the Flexible Family Funds monthly stipend amount, any dollar appropriation broken out for Flexible Family Funds or Individual and Family Support, ICF/IID per diem rates (facility-specific, not published on the fee schedule index), and average wait time on the registry. The LDH waiver landing pages returned errors on direct retrieval during this session; the substantive Louisiana content here comes from lamedicaid.com fee schedules and provider manuals, the OCDD quarterly report, and the House Fiscal Division budget presentation.

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