Does Medicaid Cover Home Health Care Costs?

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Does Medicaid cover home health care costs?

Yes. Medicaid covers the costs of the following home health care services for seniors who qualify:[01]

  • Health monitoring
  • Medication management
  • IV therapy
  • Injury treatment
  • Wound dressing
  • Rehabilitative therapies
  • Pain management
  • Medical testing
  • Skilled nursing

The above services are provided in a patient’s residence by licensed health care professionals, such as a registered nurse, licensed vocation nurse, or an occupational, physical, or speech therapist.

Medicaid eligibility requirements for home health care

Medicaid eligibility differs from state to state. In most states, home health care is a guaranteed benefit for seniors who require a nursing home level of care.

Nursing home level of care is often determined by an assessment of a person’s physical ability to perform daily tasks, their medical needs, and behavior. Also considered is an individual’s financial status, and states typically rely on income thresholds set by the Social Security Administration. In 2024, an individual qualifies for Social Security Income (SSI) if their monthly income is less than $1,971.[02]

Will Medicaid pay for 24-hour home health care?

Some state Medicaid programs cover private duty nursing for individuals who require more advanced medical care, like 24/7 nursing care. These 24-hour skilled nursing services might be covered in the event a patient needs a feeding tube, IV medications, or mechanical ventilation.[01]

Eligibility criteria for these private duty nursing programs vary by state, but a common requirement is a stated medical need for round-the-clock skilled nursing services. In a number of states, Medicaid only covers part-time home health care with a limited number of service hours per day.

Will Medicaid pay for home health care by a family member?

No, unlicensed family caregivers won’t be paid for home health care services. A home health care provider must meet a number of federal and state licensing requirements to be covered by Medicaid.

Medicaid-covered home health care agencies are supervised by a doctor or registered nurse and primarily offer skilled nursing and therapy services designed to meet your loved one’s medical needs.[03] The agency could be publicly operated, a nonprofit organization, or a private company. Medicaid pays those providers directly to provide care.

Does Medicaid cover in-home care?

Yes, Medicaid can cover the costs of nonmedical home care, but specific services, coverage, and eligibility requirements vary from state to state.

Although they may seem similar, home care and home health care provide different services to seniors.

Medicaid typically pays an approved home care agency directly for all services necessary to keep a senior living in their own home. In-home care services covered by Medicaid vary, but often include help with activities of daily living and other tasks like the following:

  • Bathing
  • Dressing
  • Continence care
  • Mobility
  • Cooking
  • Cleaning
  • Transportation
  • Household chores

Medicaid eligibility requirements for in-home care

To qualify for in-home care through Medicaid, at a minimum, seniors must be 65 or older and meet their state’s specific financial requirements. In-home care is typically covered under home and community based services (HCBS) which, unlike home health care, is not an entitlement program. This means that enrollment in HCBS programs is not guaranteed and participants may be placed on a waitlist.

Because each state has different eligibility requirements, it’s important to review your loved one’s state Medicaid page.

Will Medicaid pay for in-home care by a family member?

Yes. In some states, Medicaid pays family members for the home care services they provide. For a family member, getting paid to provide care services can make the duty of caregiving more feasible.

Medicaid can also provide in-home care assistance for seniors who want to take direct responsibility for their care, which is referred to as self-directed care.[04]

What are home and community based services?

Home and community based services (HCBS) are designed to help Medicaid recipients continue to live in their own homes or communities instead of an institutional setting like a nursing home.[05] Generally, these services are intended for seniors, people with physical disabilities, mental illness, and intellectual or developmental disabilities.

HCBS are commonly provided through Medicaid waivers, which are a way for states to offer programs not traditionally covered by Medicaid, like nonmedical home care, adult day care, and assisted living. Nearly every state offers an HCBS waiver, however, it’s important to note that unlike state Medicaid plans which are entitlement programs, participation in waivers is usually capped. This means that many waiver programs have a waitlist.

Because each state provides HCBS in a different way, the requirements to qualify for these programs vary. Check the Medicaid state waivers list for more information on specific waivers in your state.

How do you find home care?

If you’re looking for home care or home health care for an elderly loved one, reach out to their state’s Medicaid office for more information. Individual state offices can provide guidance on eligibility requirements and applying for coverage. You can also contact your local Area Agency on Aging, which can direct you to resources that help seniors remain in their homes.

For seniors who do not qualify for Medicaid but are still interested in learning more about the benefits of in-home care, A Place for Mom can help. Our Senior Living Advisors can help your family explore home care options in your area that fit your budget — all at no cost to you. Please note that A Place for Mom cannot refer to Medicaid-only facilities or home care agencies.

This article originally appeared on APlaceForMom and was syndicated by MediaFeed.

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