Does Medicaid Cover Home Care?
- July 9, 2021
Medicaid covers home health care in all 50 states. And while coverage is sure to vary from one state’s Medicaid program to another, below is an overview of some general information pertaining to Medicaid’s coverage of home health care.
Why Medicaid pays for home health care
Home health care provides seniors with an alternative to institutionalization. Individuals who require regular care can age in place in the comfort and familiarity of their own home in the presence of loved ones.
For Medicaid programs, home health care is a lower cost option than paying for beneficiaries to stay in and receive care in nursing homes or other institutions.
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How to choose your Medicaid caregiver
Medicaid often allows beneficiaries to choose their own caregiver. Beneficiaries can designate a family member or friend as their paid primary caregiver who will be reimbursed by Medicaid for their service. Select states even allow a spouse to be hired as the primary caregiver.
You also do not have to be in your own home to receive home health care benefits from Medicaid. Home care coverage may be extended to the home of a friend or relative, adult foster care home or assisted living home.
Medicaid coverage of home care
Federal law requires all state Medicaid programs to provide home health benefits. Personal care coverage – such as help with eating, dressing and bathing – is not included as a federally mandated benefit, but many state Medicaid programs choose to cover these services on their own.
Some of the home health care services that may be included by Medicaid include:
- Assistance with activities of daily living (ADL), such as bathing, mobility, dressing, eating and toileting
- Assistance with instrumental activities of daily living (IADL), which includes shopping, laundry, housecleaning and meal preparation
- Home modifications to help with living in the home, such as bathroom grab bars or wheelchair ramps
- Vehicle modifications to improve accessibility and use
- Durable medical equipment such as wheelchairs or walkers
- Adult day care
- Skilled nursing care
- Respite care
- Transportation
- Physical, occupational and speech therapy
- Meal delivery
- Personal Emergency Response Services (PERS)
In addition to regular Medicaid coverage of home health care, there are also a few specialized Medicaid programs that beneficiaries can utilize to receive home health benefits. These include:
- Community First Choice (CFC). This program allows participating states to provide in-home personal attendant services to assist with activities of daily living and instrumental activities of daily living.
- Section 1915(i) Home and Community Based Services (HCBS). This program allows individuals to receive in-home care assistance including skilled nursing care services, respite care and home modifications to assist with aging in place.
- Section 1915(c) HCBS. Similar to the above program, the Section 1915(c) provides in-home services and support and may include coverage of durable medical equipment, adult day care, companionship care and more.
- Section 1115. This program grants states some additional flexibility concerning federally-mandated Medicaid home care benefits and can offer long-term care as well.
Who is eligible for Medicaid home care?
Any recipients of home care benefits must first be eligible for and enrolled in their state Medicaid program. Eligibility is based partly on income and assets and varies from state to state. The Medicaid programs described above also have their own eligibility criteria that can differ by state.
In addition to meeting state financial limits, there is also a certain level of care needed in order to be eligible for Medicaid home care coverage. A functional need threshold, or medical need, is required for eligibility. Exact requirements vary by state, but an assessment of the individual must demonstrate that they need assistance for a specified number of activities of daily living or instrumental activities of daily living.
Medicaid programs may have medical need requirements that differ slightly from the regular state Medicaid program.
Contact your state Medicaid program
Contact your state Medicaid program to learn more about how your home health care may be covered by Medicaid and how you might qualify for a Medicaid program offering home care benefits.
Can you have Medicaid and Medicare at the same time?
You could potentially be eligible for Medicare and Medicaid. If you are, you're considered “dual eligible.” In this case, you may qualify for a certain type of Medicare Advantage plan called a Dual Eligible Special Needs Plan (D-SNP).
You can compare plans online to find out if D-SNPs are available where you live.
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About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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