The Associated Press

BATON ROUGE - Louisiana's proposed creation of a program for in-home care for Medicaid patients who hope to avoid nursing homes is running into resistance from federal health-care officials who say it is too limited.

Under federal law, Medicaid services must be offered to all who qualify. Federal officials say the new "personal care attendant" program doesn't meet its test to ensure the state isn't discriminating by offering services to just one segment of the Medicaid population.

The limits the state placed on the personal care program raised red flags when the plan was submitted for the approval of the federal Centers for Medicare and Medicaid Services.

The issue has delayed federal approval of the proposed program that is required under a federal court settlement of a lawsuit that alleged Louisiana unconstitutionally was forcing the elderly and disabled into nursing homes.

"Part of our agreement was always the caveat that it would only apply to those coming out of a nursing home or in immediate need of nursing home care," state Medicaid Director Ben Bearden said.

Otherwise, adding the program would be too expensive, he said. "We knew CMS was going to have some problems with that."

Bearden said the state is still trying to persuade the federal government to allow the new program with the restrictions. The start of the program, which has been fought by nursing home interests, has been delayed for nearly two years.

More than 90 percent of the state's long-term care dollars - some $600 million a year - is spent on nursing home care.

Recently, the state Department of Health and Hospitals, at the Legislature's insistence, went to federal court in an attempt to scrap the program. The court said no and DHH submitted the request for federal approval.

The state budget includes $28 million for the program, which provides help with basic needs such as bathing, dressing and feeding. An estimated 1,700 people could meet program eligibility requirements.

Federal health insurance specialist Jack Allen said that the state health department has made some changes at his office's request and that those are undergoing review at regional offices in Dallas. The Centers for Medicare and Medicaid Services has until Christmas to look it over and make a decision, which ultimately will rest with the central office in Baltimore, he said.

Nell Hahn, the lead lawyer who accused Louisiana of violating the rights of elderly residents in the lawsuit, said she doesn't see anything wrong with what the state is proposing. "I don't understand the problem the feds are having with it. We are tying it to the level of need for the service," said Hahn, who works for The Advocacy Center.

More than 100 information packets have been sent to people who want to provide the services. More than 220 providers of personal care attendant services could qualify to participate in the new program.